PARADOXICAL PUBORECTALIS CONTRACTION IN PATIENTS AFTER PELVIC POUCH CONSTRUCTION

Normal defecation is associated with relaxation of sphincters during t he evacuation process. However, obstructive defecation is sometimes se en clinically manifested by abnormal contraction of the puborectalis d uring defecation rather than relaxing. This condition has not previous ly been described after pelvic pouch construction. PURPOSE: This study was done to evaluate patients for defecation difficulties caused by p aradoxical puborectalis contraction after pelvic pouch procedures. MET HODS: Prospectively, patients with defecation difficulties mere questi oned. They then underwent electromyography if they met particular crit eria. Biofeedback was offered to all patients demonstrating paradox on electromyography. Follow-up was by clinic visits and interviews. RESU LTS: After pelvic pouch construction, 13 patients were found to have p aradoxical puborectalis contraction. Twelve of 13 patients elected to have biofeedback therapy. Eleven of these 12 were available for follow -up an average of eight (1-15) months after biofeedback. Nine improved , and two had no change in their defecation difficulty. Of the initial 13, 10 had an event, either pouchitis or abdominal trauma, directly b efore their defecation problems. CONCLUSION: Paradoxical puborectalis contraction can occur in patients after pelvic pouch surgery. It shoul d be suspected in patients with defecation difficulties in the absence of an anatomic abnormality. Biofeedback is effective treatment.