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http://crossmark.crossref.org/dialog/?doi=10.1007/s00192-015-2889-0&domain=pdf
Web End = Int Urogynecol J (2016) 27:11491156 DOI 10.1007/s00192-015-2889-0
http://crossmark.crossref.org/dialog/?doi=10.1007/s00192-015-2889-0&domain=pdf
Web End = REVIEW ARTICLE
Descending perineum syndrome: a review of the presentation, diagnosis, and management
Zaid Chaudhry1 & Christopher Tarnay1
Received: 10 June 2015 /Accepted: 2 November 2015 /Published online: 11 January 2016 # The International Urogynecological Association 2016
AbstractIntroduction and hypothesis Defecatory dysfunction is a relatively common and challenging problem among women and one that practicing pelvic reconstructive surgeons and gynecologists deal with frequently. A subset of defecatory dysfunction includes obstructed defecation, which can have multiple causes, one of which is descending perineum syndrome (DPS).
Methods A literature search was performed to identify the pathophysiology, diagnosis, and management of DPS. Results Although DPS has been described in the literature for many decades, it is still uncommonly diagnosed and difficult to manage. A high index of suspicion combined with physical examination consistent with excess perineal descent, patient symptom assessment, and imaging in the form of defecography are required for the diagnosis to be accurately made. Primary management options of DPS include conservative measures consisting of bowel regimens and biofeedback. Although various surgical approaches have been described in limited case series, no compelling evidence can be demonstrated at this point to support surgical intervention. Conclusions Knowledge of DPS is essential for the practicing pelvic reconstructive surgeon to make a timely diagnosis, avoid harmful treatments, and initiate therapy early on.
Keywords Anal incontinence . Descending perineum syndrome . Obstructed defecation
Introduction
Descending perineum syndrome (DPS) is an uncommonly discussed condition associated with obstructed defecation. It is described as increased bulging of the perineum with straining, although perineal descent can also be seen at rest. It was first illustrated by Porter in 1960 in a woman with a history of chronic constipation noted to have a perineal bulge on Valsalva [1]. Several years later, it was described as a discrete clinical syndrome noted in patients with a history of constant straining during defecation [2, 3]. DPS is likely overlooked as a cause of obstructed defecation and is similarly under-represented in the current literature. The aim of this narrative review is to examine the existing literature on the presentation, pathophysiology, diagnosis, and management of DPS. This information can be important for clinicians in allowing them...