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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35741
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I had a defecography test last week, and obviously I cannot

Resolved Question:

I had a defecography test last week, and obviously I cannot show you the x-ray photos. Not even I have possession of them at this time, but what I do see is a brief verbal report, and I am wondering if you can interpret what it might mean. During the procedure, they record a resting anorectal angle, and in my case, it was 120 degrees. When asked to strain, the angle remained at 120 degrees, (essentially unchanged is what it actually says in the report) and absolutely none of the contrast which was put in to my rectum was expelled. There's nothing else to interpret other than what the doctor will see from the x-ray photos, but is there any interpretation that can be made from the verbal report? If so, what does it all mean? Thank you.
Submitted: 5 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 5 years ago.

An unchanged angle on straining and inability to expel the contrast point to decreased functions of the rectum muscles. This can be rectal inertia. A pelvic floor electromyography is advised to look for the function of the puborectalis muscle with a colonic transit time for the further evaluation.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Dr. Arun
Customer: replied 5 years ago.

Can you explain what you mean in should I say more down to Earth, less physics terminology? I understand that you're suggesting there should be another test done for further investigation, but what exactly do you mean is going on mechnically? One observation which has been noted and at this point a well known phenomenon which I caused myself with my own mind by resisting defecation for an extended period of time due to a fissure in 2005 is the more I strain, the tighter the anal canal becomes. If one were to insert his/her finger in to it, and I pushed, that canal would wrap itself around the finger very tightly, so it makes perfect sense why no barium could be released as I was pushing. The canal was sealing itself up. It's the same thing which happens when they ask me to expel a balloon. These experts down at Temple University Hospital in Philadelphia know that it will tighten if I push, so how do they expect me to be able to push a balloon out? I'm pretty sure that's why no barium contrast comes out. It's exactly the same reason. The only way stool can be released from my body is if it's loose and effortless basically because of the high tone of the external anal sphincter. It's tight enough at rest as it is and tightens up a lot more if I push. So again my question really is what is mechanically going on. Can you try to explain one more time? You seem to understand this quite well yourself.

Expert:  Dr. Arun Phophalia replied 5 years ago.

There can be two problems inferred with the report;

1) The muscles of rectum are not working.
2) Or there is a tight sphincter which is causing outlet obstruction.
Both the things can be concomitant.

So apart from balloon expulsion test; which is already done, an EMG also is required to see if the nerves and muscles are affected of the pelvic floor which forms the external sphincter. That will guide the further protocol of the management.

It is privilege assisting you.

Dr. Arun
Dr. Arun Phophalia and other Health Specialists are ready to help you
Customer: replied 5 years ago.
Thank you, ***** ***** This will certainly provide some more insight to my physician tomorrow.
Expert:  Dr. Arun Phophalia replied 5 years ago.
You are very welcome.
Good luck.