Lateral division of the puborectalis muscle in the management of severe constipation

✍ Scribed by Dr. M. A. Kamm; P. R. Hawley; J. E. Lennard-Jones

• Publisher: John Wiley and Sons
• Year: 1988
• Tongue: English
• Weight: 389 KB
• Volume: 75
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800750713

✦ Synopsis

Patients with severe constipation often do not 'relax' their pelvic floor during defaecation. Electromyography of the pelvic floor may reveal inappropriate contraction during defaecation straining, and balloon expulsion, a test of rectal evacuation, may be impaired. Fifteen patients with severe idiopathic constipation and three patients with a megarectum underwent lateral division of the puborectalis muscle and upper half of the external sphincter muscle. Twelve patients had a unilateral division and six patients had both sides divided. Surgery caused a marked reduction in the maximum voluntary squeeze pressure in the anal canal from a pre-operative mean of 90 +/- 49 (s.d.) cmH2O to a postoperative mean of 40 +/- 29 cmH2O (P less than 0.0001). Four patients, three with idiopathic constipation and one with megarectum, experienced symptomatic improvement. Three of these patients had a bilateral division. Improvement did not correlate with a change in the puborectalis electromyography or the ability to expel a balloon. Three patients experienced mild mucus or urge incontinence, but no patient was incontinent for solid stool.