PROCTOGRAPHIC FEATURES OF ANISMUS

PURPOSE: To document the proctographic features of anismus at evacuati on proctography and determine the optimum radiologic measurements for diagnosis. MATERIALS AND METHODS: Twenty-four patients with anismus ac cording to clinical and multiple physiologic criteria were examined wi th evacuation proctography. Structural and functional measurements wer e compared with those of a group of 20 asymptomatic subjects. RESULTS: No significant difference between patients and control subjects was f ound with respect to pelvic descent, rectocele, or any anorectal angle measurement In patients with anismus, initiation of evacuation was pr olonged (median, 9 vs 3 seconds for control subjects; P < .0001) and a nal canal width was reduced (median, 0.6 vs 1.2 cm; P = .0075). Evacua tion time was increased (median, 50 vs 10 seconds; P < .0001), and the percentage of contrast material evacuated was decreased (median, 60% vs 100%; P < .0001). Only four patients were able to evacuate more tha n 66% of the contrast material within 30 seconds, whereas all control subjects were able to do so. CONCLUSION: Measurement of the anorectal angle to diagnose anismus should be abandoned. Patients with anismus d emonstrate delayed initiation of evacuation, which is also prolonged a nd incomplete. Incomplete evacuation after 30 seconds is highly sugges tive of anismus.