Abstract
The function of the pubococcygeus muscles during defaecation straining was compared in 10 women with obstructed defaecation and 12 age-matched control subjects. Video-proctography in each patient showed failure to evacuate the rectum and sagging of the pelvic floor during attempted defaecation. Trans-perineal concentric needle electromyography in the puborectalis muscle and transvaginal electromyography in the pubococcygeus muscle was carried out during defaecation straining and during attempted rectal balloon expulsion. Contraction of the pubococcygeus muscle was observed in 10 of the 12 control subjects and in 2 of the 10 patients with obstructed defaecation (P<0.005). Virtually equal proportions of subjects in each group showed relaxation or contraction of the puborectalis muscle during straining. There was significant perineal descent on straining in the patient group (P=0.005). This group of patients with obstructed defaecation showed failure of the pubococcygeus muscles to contract, perhaps due to neuropathic weakness of the muscles. The puborectalis muscle did not cause obstructed defaecation in these patients, and the concept of “paradoxical” contraction of this muscle is questioned.
Résumé
L'action des muscles pubo-coccygiens durant les efforts de défécation a été comparée chez 10 femmes avec une dyschésie et 12 sujets contrôle appareillés pour l'âge. Une défécographie montrait chez chaque malade un défaut d'évacuation du rectum et un abaissement du plancher pelvien durant les efforts de défécation. Une électromyographie trans-périnéale par aiguilles dans le muscle pubo-rectal et trans-vaginale dans le muscle pubo-coccygien a été réalisée durant les efforts de défécation et durant les essais d'expulsion d'un ballonnet rectal. Une contraction du muscle pubo-coccygien a été observée chez 10 des 12 sujets contrôles et chez deux des dix patientes avec une dyschésie (P<0.005). Une proportion pratiquement égale de sujets dans chaque groupe montrait un relâchement ou une contraction du puborectal durant les efforts de défécation. Il y avait une descente périnéale significative au cours de l'effort dans le groupe des patientes (P=0.005). Ce groupe de patientes avec dyschésie montre un défaut de contraction du muscle pubococcygien, peut-être dû à une faiblesse neuropathique de ces muscles. Le muscle pubo-rectal n'est pas la cause de la dyschésie chez ces malades et le concept de contraction (paradoxale) de ce muscle doit être remis en question.
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Lubowski, D.Z., King, D.W. & Finlay, I.G. Electromyography of the pubococcygeus muscles in patients with obstructed defaecation. Int J Colorect Dis 7, 184–187 (1992). https://doi.org/10.1007/BF00341217
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DOI: https://doi.org/10.1007/BF00341217