KINESIOL 1Y03 Chapter Notes - Chapter 11: Pelvic Floor Dysfunction, Internal Anal Sphincter, Radiation Proctitis
22 Jun 2018
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Disorders of defecation – constipation & incontinence
- more common in women, incontinence generally related to childbirth
Bowel movements
- relaxation of puborectalis
- internal sphincter relaxes (involuntary)
- External sphincter relaxes (voluntary)
- contraction of diaphragm to increase abdominal pressure + contraction of perineal muscles
- rectal muscles contract
Diarrhoea
Can be urge (feeling + loss of control) / passive (dementia) / flatus / urgency (feeling but no
actual loss of control) / soiling
Factors affecting bowel movement
1. Stool consistency – inf. Diarrh.
2. Higher cerebral function – dementia
3. Motility – inf. diarrh.
4. Rectal expansion – radiation proctitis (stiffening of rectal wall)
Constipation
10% population, 20% of elderly
Symptom not disease
Can be: primary or secondary
Primary: functional / slow transit / pelvic floor dysfunction
Secondary: malignancy structuring, endocrine, eating disorders, NM
Investigations
1) Colonic transit test
Measures colonic motility
Also shows whether patient lying
Give capsules on three days in different shapes, then take x-rays
2) Defecating proctogram
Give dye, then x-ray during egestion, can visualise pelvic floor + completeness of emptying
3) Anorectal Physiology tests
Use manometry catheter to sense pressure in rectum + tests anal sphincter
Basal pressure = internal anal sphincter pressure
Coughing = external anal sphincter pressure
4) Rectal balloon Distension
Shows how patient perceives rectal stretch
Can also do similar test using electrical stimulation of neurones
5) OTHERS: endo-anal USS + pelvic MRI
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Document Summary
More common in women, incontinence generally related to childbirth. Contraction of diaphragm to increase abdominal pressure + contraction of perineal muscles. Can be urge (feeling + loss of control) / passive (dementia) / flatus / urgency (feeling but no actual loss of control) / soiling. Factors affecting bowel movement: stool consistency inf. Diarrh: higher cerebral function dementia, motility inf. diarrh, rectal expansion radiation proctitis (stiffening of rectal wall) Primary: functional / slow transit / pelvic floor dysfunction. Secondary: malignancy structuring, endocrine, eating disorders, nm. Can also do similar test using electrical stimulation of neurones: others: endo-anal uss + pelvic mri. Give capsules on three days in different shapes, then take x-rays: defecating proctogram. Give dye, then x-ray during egestion, can visualise pelvic floor + completeness of emptying: anorectal physiology tests. Use manometry catheter to sense pressure in rectum + tests anal sphincter. Coughing = external anal sphincter pressure: rectal balloon distension.
