28265107 Visualization

A 51 Age - year Age - old Age G1P1 History Caucasian Personal_background female Sex with lifelong neurogenic History bladder History secondary to spina History bifida History occulta History was referred Clinical_event for symptoms of constipation Sign_symptom and ( FI Sign_symptom ).
She averaged one Bristol Diagnostic_procedure Type Diagnostic_procedure 1–2 stool Activity every Frequency 5 Frequency days Frequency requiring frequent Detailed_description manual Therapeutic_procedure disimpaction Therapeutic_procedure .
Additionally, she reported twice Frequency weekly Frequency episodes of urgent Severity fecal Sign_symptom seepage Sign_symptom , which required the use of daily Frequency continence Therapeutic_procedure pads Therapeutic_procedure .
Her symptoms did not improve with the addition of psyllium Medication and bisacodyl Medication suppositories Administration .
A defecography Diagnostic_procedure suggested atrophy Sign_symptom of the puborectalis Biological_structure and poor Sign_symptom squeeze Sign_symptom with EAS Biological_structure muscle Biological_structure atrophy Sign_symptom .
Anorectal Diagnostic_procedure manometry Diagnostic_procedure ( ARM Diagnostic_procedure ) showed a normal Lab_value resting Diagnostic_procedure pressure Diagnostic_procedure with no augmentation Sign_symptom of Sign_symptom squeeze Sign_symptom pressure Sign_symptom , consistent with weak Disease_disorder EAS Disease_disorder (Figure 1).
During bearing Activity down Activity , fixed Sign_symptom perineal Sign_symptom descent Sign_symptom was noted with the inability Lab_value to Lab_value widen Lab_value the posterior Diagnostic_procedure anorectal Diagnostic_procedure angle Diagnostic_procedure and poor Lab_value evacuation Diagnostic_procedure of Diagnostic_procedure contrast Diagnostic_procedure with straining Sign_symptom , consistent with DD Disease_disorder .
With pushing Activity , ARM Diagnostic_procedure similarly demonstrated type Lab_value IV Lab_value DD Disease_disorder , which is classified as inability to generate adequate propulsive forces along with absent or incomplete relaxation of the anal sphincter [8] (Figure 2).
Reflex Diagnostic_procedure and Diagnostic_procedure sensory Diagnostic_procedure testing Diagnostic_procedure indicated an intact Lab_value rectoanal Diagnostic_procedure inhibitory Diagnostic_procedure reflex Diagnostic_procedure and rectal Biological_structure hypersensitivity Sign_symptom .
The patient failed management Sign_symptom with home Detailed_description and conventional Detailed_description biofeedback Therapeutic_procedure therapy Therapeutic_procedure .
Following a successful trial of temporary Detailed_description SNS Therapeutic_procedure with improvement in FI Sign_symptom symptoms by 75% Lab_value , the patient had a permanent Detailed_description SNS Therapeutic_procedure placed.
One Date year Date later Date , the patient reports sustained improvement in constipation Sign_symptom and FI Sign_symptom symptoms.