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SYB: Defecogram. By Borko Kereshi , MSIII. The Case. 32 year old female with a history of: Chronic constipation Straining Irritable Bowel Syndrome . Defecogram: The Technique.

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Syb defecogram

SYB: Defecogram

By BorkoKereshi, MSIII


The case
The Case

  • 32 year old female with a history of:

    • Chronic constipation

    • Straining

    • Irritable Bowel Syndrome


Defecogram the technique
Defecogram: The Technique

  • Approximately 1 hour before the study the patient ingests one bottle of thin barium to visualize the small bowel for possible enterocele.

  • Barium paste is instilled into the rectum.

  • A small metallic marker is placed on the skin near the anus.

  • The patient is imaged in the lateral projection during the following maneuvers…


The 7 steps of a defecogram
The 7 Steps of a Defecogram

  • 1: Rest

  • 2: Cough

  • 3: Squeeze

  • 4: Valsalva

  • 5: Evacuation

  • 6: Post-evacuation valsalva

  • 7: Post-evacuation rest



Cough
Cough

no incontinence during coughing


Squeeze
Squeeze

appropriate motion of the anorectal angle during the squeeze


Valsalva
Valsalva

appropriate motion of the anorectal angle during the valsalva maneuver



Evacuation1
Evacuation

Any abnormalities noted?


Evacuation2
Evacuation

Any abnormalities noted?



Evacuation3
Evacuation

Any other abnormalities noted?



Puborectalis dyskinesia
Puborectalis Dyskinesia

  • contraction of the puborectalis during evacuation (left arrow in preceding image)

  • Additionally, there is contraction of the anal sphincter during evacuation consistent with sphincter dyskinesia (right arrow)



Post evacuation rest
Post-evacuation rest

Small post void residual


  • The patient required multiple efforts of Valsalva and squeeze to evacuate the barium.

  • This impaired contraction is highly predictive of anismus

    • Anismus: malfunction of the external anal sphincter and puborectalis muscle during defecation

    • More common in women

    • Sometimes associated with sexual abuse


References
References

  • LEROI A.-M. ; BERKELMANS I. ; DENIS P. ; HEMOND M. ; DEVROEDE G. Anismus as marker of sexual abuse : consequences of abuse on anorectal motility. Digestive diseases and sciences. ISSN 0163-2116. vol. 40, no7, pp. 1411-1416, 1995

  • healthlibrary.epnet.com

  • www.aboutincontinence.org


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