LAUSR

BACKGROUND Despite the widely accepted association between excessive straining and perineal descent, the clinical significance of perineal descent in patients with obstructed defecation syndrome is still unclear. OBJECTIVE To evaluate the prevalence of pathological perineal descent in patients with obstructed defecation syndrome and the impact of perineal descent on symptoms severity. DESIGN This was a prospective multi-center uncontrolled study. SETTINGS The study involved three hospital pelvic-care centers and was conducted from January 2018 to January 2022. PATIENTS The study included 141 consecutive adult patients with obstructed defecation syndrome-score ≥ 9 and no evidence of organic gastrointestinal pathology. All the patients underwent dynamic pelvic magnetic resonance and, in case of suspected paradoxical puborectalis contraction, anal manometry. MAIN OUTCOME MEASURES Main outcome measures were the prevalence of excessive perineal descent and the correlation between perineal descent and obstructed defecation syndrome-score. RESULTS One hundred twenty-eight (90.7%) patients completed magnetic resonance examination and were included in the analysis. Of these, 18 (14.1%) had a physiological perineal descent and 110 (85.9%) an excessive perineal descent. Excessive perineal descent was found in 46.1% (12/26) of patients with magnetic resonance signs of paradoxical puborectalis contraction and in 96% (98/102) of patients with normal puborectalis relaxation. In these last patients, a good correlation between obstructed defecation syndrome-score and maximum perineal descent during straining was found (Spearman r test: 0.68; p < 0.0001). LIMITATIONS The study was limited by the small sample size and by the strong selection of study population. CONCLUSIONS The excessive perineal descent is a common finding in patients with obstructed defecation syndrome and high symptoms score, occurring almost constantly in patients without paradoxical puborectalis contraction. In the last patients the maximum perineal descent seems to be well correlated with symptoms severity. See Video Abstract at http://links.lww.com/DCR/C135.