ANTERIOR RECTOCELE AND ANORECTAL DYSFUNCTION

The two types of anterior rectocele, ''distension'' or Type 1 rectocel e (T1R) and ''displacement'' or Type 2 rectocele (T2R), have different anatomical, clinical and therapeutic profiles. The aim of this study was to assess anorectal function in patients with distension or displa cement rectocele. Three groups of female patients and one group of hea lthy female subjects were studied. Both the 10 Group 1 subjects, who h ad been diagnosed as having T1R, and the 10 Group 2 women who had been diagnosed as having T2R, were symptomatic for digital evacuation of t he rectum. The 10 Group 3 females had complained of severe idiopathic constipation but had no defecatory disorders. The control group was ma de up of 10 healthy volunteers. All patients and controls underwent cl inical evaluation, colonic transit time (CTT), computerized anorectal manometry (CAM), and defecography. Bowel movements and clinical evalua tion were similar for both rectocele groups. In Group 1, CAM detected significantly higher anal pressure (P < 0.05) and more impaired rectoa nal inhibitory reflex (RAIR) (P < 0.01) in comparison to the other pat ients and controls. In Group 2, the lowest anal pressure (P < 0.001) w as noted but RAIR was normal. Defecographic results, at rest and durin g evacuation, showed a significantly (P < 0.001) higher anorectal angl e and a more abnormal pelvic floor descent in Group 2 than in the othe r study groups and controls. Therefore, peculiar anorectal function wa s present in patients with anterior rectocele. A pelvic floor dyssyner gia was noted in the distension rectocele group, while a fall of the p elvic floor was noted in the displacement rectocele group.