Rectoanal inhibition and rectocele: physiology versus categorization

Some authors divide rectoceles into those with chronic evacuatory difficult y and normal genital position (type 1) and those with associated pelvic org an prolapse (type 2). This study assessed whether there are physiological d ifferences between these two clinical rectocele types. Female patients were assessed by conventional anorectal manometry, vector manometry, parametric assessment of the rectoanal inhibitory reflex (RAIR), and defecography. Su bjects included 33 volunteer controls without anorectal disease, 14 patient s with type I rectocele, and 26 patients with type II rectocele. Significan t differences were noted for resting pressure measurements (maximal resting anal pressure and vector volume) between rectocele types and between type 1 patients and controls. Significant differences were noted for squeeze par ameters (maximal squeeze pressure and vector volume) only between rectocele types. There were minimal differences in parameters of the RAIR, with a re duced slope of inhibition in the proximal sphincter for both rectocele grou ps and a reduced maximal inhibitory pressure in the intermediate and distal sphincter of type 1 rectocele patients. There were no differences in trans ient excitation of the pressure wave during the RAIR reflex to account for pressure variations with no measured differences in rectocele depth (type 1 , 2.87 +/-0.7 cm; type 2, 2.84 +/-1.4 cm) There are few physiological diffe rences between the different clinical categories of rectocele patients base d on the presence or absence of associated genital prolapse.