spastic pelvic floor syndrome

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  1. spastic pelvic floor syndrome
    • obstructed defecation
    • anismus
    • paradoxical puborectalis muscle contraction
  2. sx
    • prolonged straining at stool
    • feeling of incomplete evacuation
    • requirement for manual assistance
    • use of laxatives and enemas
  3. PE
    may be a rectocele
  4. dx tests
    • ballon expulsion most reliable
    • objective findings:
    • manometry: paradoxical elevation of pressure when patient tries to evacuate
  5. rx
    • biofeed back:balloon expulsion, EMG, manometric
    • Botox (6-15 u b/l EAS or PR/ max 3 doses in 3 months)-results short term and temporary
    • alternatives described in literature: rectopexy (12%), PR muscle division27%, anal dilation, antegrade colonic irrigation, sacral nerve stimulation
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spastic pelvic floor syndrome
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