Defecographic Subgroups of Pelvic Floor Dyssynergia and Their Relation to Biofeedback Therapy

Byeon, Jeong Sik; Myung, Seung Jae; Yang, Suk Kyun; Yoon, In Ja; Kwon, Oh Ryoun; Ko, Jung Eun; Kim, Ah Young; Ha, Hyun Kwon; Lee, Gin Hyug; Jung, Hwoon Yong; Hong, Weon Seon; Kim, Jin Ho; Min, Young Il

Abstract

BACKGROUND/AIMS
We classified pelvic floor dyssynergia (PFD) patients according to the various relaxation patterns of the external anal sphincter and puborectalis observed at defecography. We also assessed the physiological and clinical significance of these subgroups related to the results of biofeedback therapy.
METHODS
We classified 93 patients (M:F = 31:62, age 16~82 yrs) diagnosed with PFD into 3 defecographic subgroups: (a) an anal sphincter type (n = 22), with an increase of anorectal angle (ARA) more than 20 degrees and an anal canal opening (ACO) less than 15 mm during defecation; (b) a puborectalis type (n = 18), with an increase of ARA less than 20 degrees and ACO more than 15 mm during defecation; and (c) a combined type (n = 53), with an increase of ARA less than 20 degrees and ACO less than 15 mm during defecation. We compared these 3 types of PFD by physiological variables and clinical findings, including biofeedback responsiveness.
RESULTS
Resting anal sphincter pressure was higher in the anal sphincter type and the combined type than in the puborectalis type. The defecation index was lower in the anal sphincter type and the combined type than in the puborectalis type. The biofeedback response rate was higher in the puborectalis type than in the anal sphincter type and the combined type.
CONCLUSIONS
This study showed that 3 defecographic types may denote distinct subgroups of PFD, and these subgroups have different biofeedback response rates.