Puborectal hypertrophy



Puborectalis syndrome is a defecation disorder characterized by puborectal tendon hypertrophy, which causes obstruction at the outlet of the pelvic floor. Histological changes are characterized by puborectal muscle fiber hypertrophy. Due to the stenosis of the upper end of the anal canal caused by hypertrophy of the puborectalis muscle fiber, the patient has long-term defecation difficulty, repeated history of laxative application and multiple history of anorectal surgery. In recent years, through further research, some new understandings have been made on the treatment of intrinsic. Some people think that the treatment method should be carefully selected according to the degree of the disease in order to improve the curative effect.



The cause is still unclear, and may be related to factors such as the abuse of laxatives and pelvic floor tendon in chronic inflammation around the anal canal (such as abscess in the rectal rectum).


an examination

1. Rectal examination: the anal canal tension is increased, the anal canal is prolonged, the puborectalis muscle is obviously hypertrophied, tender, and sometimes has sharp edges.

2. Measurement of anal canal pressure: The narrowing pressure is increased, suggesting an abnormal defecation curve, and the sphincter function length is significantly increased, up to 5.0 to 6.0 cm.

3. Airbag forced out test: 50ml or 100ml airbags can not be discharged from the rectum, and discharged within 5min when normal.

4. Pelvic EMG: The puborectal muscle has significant abnormal myoelectric activity.

5. Colonic transmission function check: There is rectal retention.

6. Defecation angiography: The measurement data is still normal, but the anal canal does not open when defecation, and there is a attic sign when it is still and forced to drain.


Differential diagnosis

The disease should be differentiated from the pelvic floor tendon syndrome, which is a functional disease characterized by spasm contraction of the pelvic floor muscles.

When the normal person is at rest, the puborectalis muscle is in a contracted state, and the muscle is loosened during defecation to facilitate the discharge of feces. If you have a squat, the puborectalis muscle does not relax, but the contraction is strengthened, which will affect bowel movements. At this time, in the dynamic contrast angiography, the rectal angle of the anal canal does not increase when squatting, and still maintains the original 90° or less. Kujipers believes that this continuous contraction during sputum represents muscle dysfunction of the pelvic floor muscles, rather than an arbitrary contraction that occurs during dynamic contrast during defecation. He named this persistent contraction as the pelvic floor tendon syndrome. The cause of this functional disorder is unclear, and similar to other dysfunctions, psychological factors may also work. The syndrome is also often associated with perineal decline, rectal intussusception, and rectocele. Treatment is based on the function of restoring normal muscles. The identification of the puborectalis syndrome is that the former manifests as pelvic floor spasm without muscle fiber hypertrophy, although the anal right angle is small, but there is a change in the X-ray film of each state during the dynamic contrast of defecation, and there is no "shelf sign". In the latter, the "shelf sign" is more visible, the anal canal is longer, and the anal straight angle is small. During the whole dynamic contrast imaging of the bowel movement, the expectorant is often not discharged or discharged in a small amount. When the diagnosis is difficult, the digital rectal examination can assist in the identification. Others believe that the two may be a manifestation of different stages of the disease.

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