The spastic pelvic floor syndrome is a functional disorder due to abnormal contraction instead of relaxation of the pelivc floor muscle during straining. This inhibits defecation and gives rise to constipation. We carried out the clinical and
psychologic analysis, defecogram, electrophysiologic tests, and treatment in 17 patients with spastic pelvic floor syndrome. The mean age of patients was 48.2±10.1 years. The male to female ratio was 1:7.5. Primary complaints were incomplete
evacuation
82.3%, constipation 52.9%, tenesmus 41.2%, straining 41.2%, and dysuria 29.4%. The patterns of personality using the MMPI showed somatization type in 7 cases and psychophysiologic reaction type in 4 cases. Defecogram revealed paradoxical
contraction of
puborectalis in 100.0% of cases, incomplete evacuation 76.5%, rectocele 58.8%, incontinence 17.6%, intussusception 5.9%, and excessive pelvic floor descent 5.9%. The anorectal angle in patients did not increase during straining and remained bout
90°.
The mean maximum resting and squeezing anal canal pressures were 94.4±48.4mmHg, and 136.4±28.8mmHg. Seven patients(70.0%) were unable to expel a balloon. The pudendal neuropathy revealed in 4 patients(40.0%). Seven patients underwent a EMG
based
biofeedback therapy. Four among them(57.1%) had increased bowel frequency and improved the symptom of incomplete evacuation. In conclusion, careful history taking, physical examination and colorectal motility tests permit diagnosis of spastic
pelvic
floor syndrome. This disease is related with incoordination of pelvic floor muscle, so treatment should be aimed at restoration of normal muscle function through biofeedback. (Korean J Gastroenterol 1994 ; 26 : 482-490)
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