Case contributed by Dr Vikas Shah


Difficult defaecation

Patient Data

Age: 30 years
Gender: Female

This is the evacuatory phase of a fluoroscopic defecating proctogram. Multiple attempts have been made at evacuation but none of the barium paste is expelled and there is no appropriate opening of the anorectal angle.

Case Discussion

The appearances are suggestive of anismus, also known as anorectal dys-synergy. The same findings can also be caused by situational anxiety; therefore, they must be correlated with the symptoms and examination findings, and other tests such as the balloon expulsion test. 

In anismus, there is no appropriate relaxation of the levator sling during evacuation, resulting in maintenance of an acute anorectal angle and no opening of the anal canal.

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Case information

rID: 50578
Published: 7th Mar 2018
Last edited: 7th Mar 2018
Inclusion in quiz mode: Included

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