Psychodynamic and biodynamic analysis of treatment of outlet obstructive constipation (OOC) using Procedure for Prolapse and Hemorrhoids (PPH)

Application of dynamic MRI defecography in diagnosis of outlet obstructive constipation

AIM

To assess the application value of dynamic magnetic resonance imaging (MRI) defecography in the diagnosis of outlet obstructive constipation (OCC).

METHODS

Forty-eight patients with suspected OOC at Third Affiliated Hospital of Nanchang University from March 2016 to February 2018 were selected, and they underwent dynamic MRI defecography and X-ray defecography. The situations of dynamic MRI defecography and X-ray defecography were recorded. Using X-ray defecography as the standard, the specificity, sensitivity, negative predictive value, and positive predictive value of dynamic MRI defecography were calculated.

RESULTS

There was no statistical difference in the diagnosis of intersigmoid hernia, puborectalis spasm, hernia, or internal hemorrhoid between dynamic MRI defecography and X-ray defecography (P > 0.05). The detection rates of dynamic MRI defecography in the diagnosis of rectocele, rectal mucosal prolapse, perinaeum descent, intrarectal invaginate, and sigmoid colon zigzagging were lower than those of X-ray defecography (P < 0.05). Dynamic MRI defecography could find lesions that cannot be displayed by X-ray defecography, including muscular rupture, uterine fibroid, cervical accepts cyst, sacral cyst, and mullerian duct cyst. Using X-ray defecography as the gold standard, the specificity and positive predictive value of dynamic MRI defecography in the diagnosis of rectal mucosal prolapse, rectocele, puborectalis spasm, intrarectal invaginate, intersigmoid hernia, hernia, sigmoid colon zigzagging, and perinaeum descent were all 100.00%; the sensitivity and positive predictive value for different diseases had a significant difference, the positive predictive value was generally higher, and the sensitivity was usually lower.

CONCLUSION

MRI and X-ray defecography have their own advantages in the diagnosis of OOC. Dynamic MRI defecography can provide information on the pelvic organ and pelvic wall, pelvic floor function, and morphological structure, and it is a good supplement to X-ray defecography. Dynamic MRI defecography can provide guidance for overall evaluation and comprehensive diagnosis of OOC with pelvic multiple-organ lesions.

Women's experiences of managing digitation: do we ask enough in primary care?

The aim of this paper was to consider the available evidence for the current management of pelvic organ prolapse, which is a common presentation in primary care. However, not all women will present, only presenting when symptoms become bothersome. Particular attention was paid to understanding the problem of rectocele and its influence on obstructive defaecation symptoms. The burden of rectocele and its consequences are not truly known. Furthermore, healthcare professionals may not always enquire about bowel symptoms and patients may not disclose them. Complex emotions around coping and managing stress add to the challenges with seeking healthcare. Therefore, the impact on the lived experience of women who have difficulty with rectal emptying can be significant. The review identified a dearth of knowledge about women living with the problem of obstructive defaecation resulting in the use of digitation. Improving the management of digitation, an under-reported problem, is necessary to improve the quality of life for women. Primary care needs to increase access to conservative measures for women struggling with bothersome symptoms, such as constipation, the need to digitate or anxiety.