The investigation of posterior compartment disorders: An integrated approach

Abstract

Posterior compartmental pelvic floor disorders include symptoms of defaecatory dysfunction and include faecal incontinence, constipation, evacuatory disorders (obstructed defaecation) and functional anal pain (levator ani syndrome or proctalgia fugax). Patients may also suffer from concomitant symptoms attributable to anterior and middle compartmental dysfunction, such as vaginal or urinary symptoms. Causation is multifactorial and may be due to anatomical and functional abnormalities and other contributing factors, such as gastrointestinal and psychological elements or chronic pain. Careful interpretation of the available investigations is vital in safe treatment of these patients. Given the complex nature of posterior pelvic floor disorders, symptoms cannot automatically be attributed to anatomical defects which may be detected on imaging.Anorectal physiology and integrated total pelvic floor ultrasound may be performed in the one-stop clinic to assess the pelvic floor’s structure and function. Other imaging modalities include defaecatory imaging in the form of evacuation proctography or defaecating magnetic resonance imaging proctogram. These investigations may provide conflicting results which can pose a challenge to the clinician and the patient. This review is based on the workshop presented at the International Continence Society Conference in 2022. The aim is to outline the pathophysiology and investigation of posterior pelvic floor compartment dysfunction, as well as discuss the implications of these investigations on patient management.