# Descending Perineum syndrome



## CalmWaters (Mar 31, 2017)

We've all been running in circles, trying to label this illness but this could be all of our issues.

https://en.m.wikipedia.org/wiki/Descending_perineum_syndrome

The symptoms include: nerve damage (loss of sensitivity, loss of inhibitory rectal-anal reflex), constipation, pain/discomfort, varying degrees of incontinence, rectocele and cystocele in women, short anal canal, etc.

There are some people with descent who do not feel symptoms. If you are trying to find a doctor, find one who knows about this rare illness. Don't let them say it's all in your head or it's conversion disorder. Find a doctor who cares about your quality of life.


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## PokerFace (Jan 13, 2017)

*WHAT IS THIS PATHOLOGY*

The syndrome of the descending perineum

The descending perineum was first described in 1966 by Alan Parks and is:

"A set of anatomical and clinical conditions characterized by the reduction of tone and alterations in the functioning of voluntary and involuntary muscle structures, of the rectum, of the anal sphincters and of the anus lift, as well as the means of rectal fixation."

These alterations manifest themselves with a lowering of the perineal muscular plane already present at rest and which is accentuated during the pushes for the evacuation with the descent of the ano-rectal angle over 2 cm below the pubo-coccygeal line.

The anatomical and physiopathological complexity of the perineum, in which the rectum, the bladder, and, in the woman, the vagina and the uterus are rested and intercourse in the woman, imposes and justifies a multidisciplinary approach to the subject that must understand and consider methods. investigation and urological, gynecological, neurological and obviously proctological diseases.
It should be noted that these are however pathologies that occur more frequently in the female sex and that show similar histopathological and electrophysiological characteristics for which it is justified to consider a common involvement in the origin of their formation.

The pelvic floor can be considered a "cradle" of muscles and bands, concave at the top, which welcomes and supports the bladder, the lower part of the rectal ampoule and, in the woman, the upper part of the vagina and the uterus and is constituted from the ischio-, ilo-, and pubo-coccygeal beams of the anus.

The pubo-rectal muscle, although belonging to this latter complex musculature, has a greater role as a sphincter than as a support for which it must not be included among the muscles that make up the "floor" in the strict sense of the term. However, it too is integrated into maintaining the correct position and proper functioning of the perineal plan.

Muscle innervation is guaranteed by branches of the sacral plexus (S2-S4). A band of thin tissue (aponeurotica) completely covers the pelvic floor by sending expansions around each of the organs that cross it: a real jatal ligament is created in these points.

These structures guarantee the support of the pelvic viscera both in resting conditions and during the dynamic phases (urination, coughing, pamping, childbirth) because the described structures do not directly weigh on the muscular structures but are hung from the pelvic girdle by means of the connective tissue of the endopelvic band. The density of the endopelvic fascia fibers decreases after the meopause, predisposing to a descent of the pelvic floor and the structures contained in it.

However, there are other factors that alter the balance between support mechanisms and visceral pressure: delivery, defecation disorders, and increased intra-abdominal pressure. In this way the pathophysiological conditions of the Descending Perineal Syndrome (SPD) are created, where a descent already present at rest of the perineal plane is accentuated during the ponzamento.

A study of pelvic floor biomechanics performed by V. Piloni, A. Corvi, C. Mamorale, S. Piloni and L. Amadio has clarified the concepts of strength, tension and deformation of the structures belonging to and engaged in the pelvic floor. It has been clarified that the superelevating space acts as a receiving cavity in which the intestinal loops are mobilized temporarily, rearwardly mobilized by the action generated by the anterior abdominal wall. The deformation is felt on the visceral structures (especially in the suboperitoneal portion of the rectum) but also on the bone structures with verticalization of the coccygeal rachis.

In a condition of reposition of the rectum, this modification of the geometric configuration of the pelvis predisposes to the evacuation which is accomplished essentially by a mechanical squeezing mechanism. The anterior pelvic region behaves differently and the urination does not show mechanical squeezing and geometric configuration phenomena but rather an elastic return of the bladder walls to a depletion state admitted an adequate removal of the sub-bladder obstacle.

Recall that the normal position of the perineum is that which places the anorectal angle to 1.4 cm above the plane of the ischiatic tuberosities and that this angle drops on average by 3 cm during the phases of ponzamento.

List of therapies from Italian doc who treats this Pathology
(May explain why some procedures work for some and not for others):

*CURES/TREATMENTS:
*
Surgical therapy: Corrective treatments in the presence of SPD (Descending Perineal Syndrome)

Perineoplasty by abdominal and perineal route
Reprocessis Cystopexter Heteropexy
Mucosal prolaxectomy (also Longo technique)
Correction of rectocele
hemorrhoidectomy
Various associations

When should I intervene?
Surgery should be reserved under specific conditions, ie in the presence of:

Serious impairment of quality of life due to incontinence
Major defect
Failure of medical and rehabilitative therapies

We must also consider:
Specific indication
Physical and psychic capacity of the patient
Cost-benefit ratio

What are the applications in general surgery and the treatment protocols exposed so far?
The progression of pathophysiological and oncological knowledge and laparoscopy have modified the treatment of neoplasms of the middle-lower rectum, allowing a less destructive approach to abdominoperineal amputation with terminal ileopolecomy packaging that was once the therapeutic "gold standard".

During this new therapeutic approach, however, there are some pathophysiological changes with changes in pelvic floor dynamics that can determine an altered evacuation function characterized by:

Reduced sensitivity of residual ano-rectal mucosa
Sphincter suffering
Loss of the inhibitory rectal-anal reflex
Reduced (or absent) rectal compliance
Damage of the pudendal nerve
The possible consequences are:

Number of high evacuations
Some degrees of incontinence
Incomplete evacuations
Constipation
Based on current regional laws:
Patient associations must be promoted
A network of services for the prevention, diagnosis and treatment of urinary and anal incontinence must be approved
A database and national register with adequate territorial distribution must be created
A regional incontinence commission consisting of multiple specialists and a regional official must be established
An analysis of costs and therapeutic efficacy must be performed
The Regional Director of the Health Planning Department is responsible for appointing the referents

https://www.lucapassarella.it/it/trattamenti/trattamenti-per-l-incontinenza-anale/terapia-chirurgica-trattamenti-correttivi-in-presenza-di-spd-sindrome-del-perineo-discendente


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## PokerFace (Jan 13, 2017)

Celsius can you put a list of docs who treat that in the US. It would make it easier to adress the gas incontinence for some since most of docs call them psychos


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## horizonzero (Nov 17, 2013)

In my defecography they stated that i had no descent of the perineum yet symptoms still persists


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## PokerFace (Jan 13, 2017)

Yeah its not one fits all but accounts for gas i lncontinence which is huge since most of docs deny it


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## CalmWaters (Mar 31, 2017)

Horizonzero, there are many levels of descent, they probably dismissed it. Go to a pelvic floor specialist and request Pelviperineal kinesitherapy and sensory biofeedback. I messaged a doctor online, and he mainly told me this. He said flatal incontinence is a precursor to full blown fecal incontinence, which is why our stool was turtling far into the rectum.


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