Descending perineum syndrome: Audit of clinical and laboratory features and outcome of pelvic floor retraining

Objective: Our aim was to retrospectively analyze the Mayo Clinic experienc e of descending perineum syndrome from 1987-1997, Methods: Clinical records were abstracted for demographic features, risk factors, results of anorect al and defecation tests, and a mailed questionnaire evaluated outcome and c urrent symptoms. Results: All results are mean +/- SD. Clinically, 39 patie nts (38 women, one man), mean age 53 +/- 14 yr, presented with constipation (97%), incomplete rectal evacuation (92%), excessive straining (97%), digi tal rectal evacuation (38%), and fecal incontinence (15%). Laboratory tests showed anal sphincter resting pressure was 54 +/- 26 mm Hg, and squeeze pr essure was 96 +/- 35 mm Hg; expulsion from the rectum of a 50-ml balloon re quired > 200 g added weight in 27%; perineal descent was 4.4 +/- 1 cm (norm al < 4 cm) by scintigraphy. Scintigraphic evacuation, rectoanal angle chang e during defecation, and perineal descent were abnormal in 23%, 57%, and 78 % of the patients, respectively. Associated features included female gender (96%), multiparity with vaginal delivery (55%), hysterectomy or cystocele/ rectocele repair (74%). On follow-up, 64% responded; 17 of these 25 respond ers underwent pelvic floor retraining. At 2-yr median follow-up (range, 1-6 yr), 12 still experienced constipation or excessive straining; their perin eal descent was greater than in patients who responded to retraining (p = 0 .005). Conclusions: Descending perineum syndrome is identifiable by clinica l history and examination, and the most prevalent abnormality on testing is perineal descent > 4 cm; rectal balloon expulsion is an insensitive screen ing test for descending perineum syndrome. Pelvic floor retraining is a sub optimal treatment for this chronic disorder of rectal evacuation; the exten t of perineal descent appears to be a useful predictor of response to retra ining. (C) 1999 by Am. Cell. of Gastroenterology.