EVACUATION PROCTOGRAPHY (DEFECOGRAPHY) - AN AID TO THE INVESTIGATION OF PELVIC FLOOR DISORDERS

Patients with pelvic floor disorders frequently have associated anorec tal dysfunction, which can be evaluated by a variety of laboratory tes ts. Evacuation proctography (defecography) documents the process of re ctal evacuation and therefore demonstrates disorders of defecation, pa rticularly those of an obstructive nature. It provides objective infor mation about rectocele size and emptying and demonstrates coexistent e nteroceles, many of which are missed on physical examination. This rad iographic technique is the method of choice for recognizing rectal int ussusception, the mechanism by which rectal prolapse occurs. Proctogra phy suggests the diagnosis of spastic pelvic floor (anismus), a disord er amenable to biofeedback therapy. Proctography has limited applicati on in anal incontinence unless there are associated obstructive sympto ms. Evaluation of bladder dysfunction is aided by concomitant cystogra phy. Gynecologists managing pelvic door disorders should assess coexis tent anorectal dysfunction, as undiagnosed enteroceles and disorders o f defecation are an important cause of persistent or recurrent symptom s following pelvic floor repair. A comprehensive interdisciplinary app roach to pelvic floor disorders is recommended.