1.1 Study Design and Patients
The clinical data for which ODS related to MRSW had been diagnosed using defecography were prospectively collected and retrospectively analyzed from January 2017 to June 2022 at the Tianjin Union Medical Center. The anorectal function of the 3D HRAM was evaluated prior to pelvic floor biofeedback therapy. Sixty HSW were recruited to perform the 3D HRAM anorectal function evaluation for the control group. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement 17 was used to conduct the case control study and was approved by the ethics committee of Tianjin Union Medical Center. The Declaration of Helsinki serves as a statement of ethical principles for our medical research involving human subjects 18. All patients and volunteers provided their informed consent in writing.
1.2 Subject Inclusion Criteria:
Women aged ≥ 18 years, and ≤ 85 years;women aged < 18 years ≥ 18 years, and < 85 years; Normal bowel movements within 6 months before enrollment: stool frequency < 3 times / day and < 3 times / week. The type of stool was Bristol 3–5, the duration of bowel movements was < 10 minutes, and there was no strain of the bowel movements, incomplete bowel movements, difficult or hand-assisted bowel movements, intestine-related movements, abdominal pain, intestine-related pain or fecal incontinence. The digital rectal examination is a normal physical examination. No medication was taken during the 3 months prior to enrollment.
1.3 Patient Inclusion Criteria:
All cases were diagnosed according to the Rome IV diagnostic criteria for functional gastrointestinal disorders 19. Women aged ≥ 18 years, and < 85 years; Diagnosis of rectocele < 3.0 cm, rectocele with perineal descent < 3.5 cm or rectocele with mild to moderate rectal mucosal prolapse by defecography.
1.4 Patient Exclusion Criteria:
Pregnant women; Chronic systemic diseases such as heart, lung, liver and kidney disorders; Patients with DD, megacolon, and fecal incontinence are identified by fecalography or 3D HRAM; Patients are diagnosed with slow slow transit constipation by the slow slow transit test; Psychotic disorder or incompatibility.
1.5 3d Hram Studies
The patients received 80 ml of glycerine enema to clean the lower rectum prior to 3D HRAM. The patient was placed in the left lateral decubitus position. A solid-state manometry assembly (ManoScan™ 3D; Sierra Scientific Instruments, Los Angeles, CA, USA) was evaluated.
The 3D-HRM probe has the following characteristics: (1) the diameter of the probe is 10 mm, and the pressure sensitive length of the probe is 64 mm; (2) There were 256 sensors on the surface of the 3D HRAM probe, which formed a continuous grid in the axial and circumferential directions, and one balloon reference sensor. (3) The spacing between the transducers is axial (4mm in length) and circumferential (2mm in width).al directions, and one balloon reference sensor. (3) The spacing between transducers is axial (4mm in length) and circumferential (2mm in width).
The first calibration point was 0 mmHg and the last was 300 mmHg. A solid probe is placed in the middle of the rectum, 10 to 15 cm from the anal edge. The 3D HRAM results were measured by an investigator with 12 years of experience in using a 3D HRAM probe. The alignment bump on the handle remained at the same reference angle as the patient throughout the procedure, regardless of any position. Depending on the physician's choice, a tiny balloon catheter may be introduced next to the manometry probe so that balloon inflation can be detected by a distal pressure transducer.
In our study, parameters were assessed in the following chronological order: anorectal pressure during rest (20 to 30s), anorectal pressure during squeezing in three attempts with a duration of sustained squeezing for 20 to 30s. During strain defecation was instructed by the investigator. After that, the volume was increased every 20 ml, until the maximum volume was 300 ml, a total of 3 times (normally 20–30s), and the RAIR and rectal sensation were evaluated at the same time. The threshold volume of the first sensation was recorded, as well as the urgency of defecation and maximum discomfort. Proprietary ManoView™ software Given Imaging was used. All pressure measurements were made with reference to atmospheric pressure.
3D HARM equipment to measure the following indicators: Rest (maximum resting pressure, mean resting pressure, HPZ length). squeezing (maximum squeezing pressure, duration of sustained squeezing). Simulated defecation (residual anal pressure, anal relaxation rate, intrarectal pressure, rectoanal pressure differential). Graded balloon distension (anorectal inhibitory reflex, first sensation, urge to defecate, discomfort ), and defecation index.
HPZ is the length of the mean pressure curve in the resting pressure framework, defined as {rectal pressure + ([anal resting pressure-rectal pressure]×0.25)}. The eSleeve function identifies the maximum positive or minimum negative difference between rectal and anal pressures during simulated defecation, measuring the rectoanal pressure differential = intrarectal pressure in 5 seconds of 20 seconds. During the assessment of RAIR and the simulated defecation. anal relaxation rate(%) was calculated from the anal pressure measured within 1.5 seconds before the procedure. Anal relaxation rate% = 1 − residual anal pressure / mean resting pressure ×100. RAIR is considered to be present if anal laxity is greater than 25%. Rectoanal pressure differential = intrarectal pressure − anal pressure. Defecation index = intrarectal pressure / residual anal pressure.
1.6 Statistical Methods
SPSS version 22.0 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Categorical data were described as numbers. Continuous data was presented as mean ± standard deviation,deviation and multivariate linear regression analysis was performed to test for the normal distribution of the data and the homogeneity of the variance. For normally distributed data, the independent sample t test was used for intragroup comparisons, and the paired sample t test was used for intergroup comparisons. Multivariate logistic regression analysis was used to screen for independent risk factors for the prognosis of MRSW. P < 0.05 was considered statistically significant.