Özet:

Aim: Both anismus and perineal descent may cause symptoms of obstructed defecation, and impaired rectal evacuation may be a major finding of anismus, or due to insufficient patient co-operation. The aim was to compare static magnetic resonance defecography (MRD) measurements in patients with anismus and perineal descent, and to identify findings which may rule out anismus in patients who can not defecate. Method: Patients with symptoms of obstructed defecation who underwent MRD between July 2016 and March 2018 were retrospectively evaluated. Thickness of anal sphincter was measured on T2W axial images. Anorectal angle (ARA) and M-line were measured on static MRD images with distended rectum. After all measurements were completed, patients were divided into two groups depending on the diagnosis indicated by MRD. Group 1 consisted of patients with findings suggesting anismus and group 2 consisted of patients with perineal descent. The measurements of ARA, M line and thicknesses of anal sphincter were compared. Results: In total 90 patients (68 female; 75.6%) were included. Group 1 consisted of 37 (20 female) patients with a mean age of 46 years. Group 2 consisted of 53 (48 female) patients with a mean age of 52 years. Both the age (p=0.039) and the gender distribution (p<0.01) differed significantly between the groups, while the thickness of the internal and external anal sphincter was not significantly different. Both the ARA measurements (p=0.025) and difference in the length of M-line (p=0.047) were significantly different between the groups on images with distended rectum. Conclusion: Patients with anismus were younger but there was no gender predilection. When the rectum was filled with contrast media, the ARA was wider and M-line was longer in patients with perineal descent.

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