Proctography is a method of X-ray examination of the rectum during defecation. It is used to visualize the distal segment of the large intestine and obtain data on its motor-evacuation function, as well as (indirectly) to display female genitalia (vagina and uterus). It is prescribed to identify dystrophic processes and assess the width of the lumen of the rectum, in parallel, women can get an idea of the tone of the muscles of the vagina. It is carried out after the introduction of a special contrast agent directly into the rectum in the form of a thick suspension. The result of the study is a series of images, it is possible to conduct a similar X-ray procedure with a video recording
Intestinal proctography is prescribed for severe ailments of the rectum and pelvic muscles, which are indicated by a number of obvious symptoms.
- Constipation. Constipation regularly affects up to half of the adult population of the Earth. However, the chronic manifestation of the symptom can cause serious harm to health. Including lead to rectal prolapse. The causes of constipation are divided into primary (congenital anomalies and developmental pathologies) and secondary (diseases and intestinal damage).Defectography is performed to examine the anorectal zone, including to calculate the anorectal angle during straining and at rest. Normally, the angle is 90 and 110 degrees, respectively. If the patient suffers from chronic constipation, it does not exceed 100 degrees.
- Fecal incontinence. Fecal incontinence is a disease in which bowel emptying occurs against the will of the patient. The symptom can be caused by a number of diseases, including constipation and diarrhea, nerve disease, pelvic floor dysfunction, damage to the rectal muscles or their weakness. In case of fecal incontinence, intestinal proctography is prescribed, because this examination allows you to assess how much stool the rectum can accommodate, how it is distributed and how the intestine copes with defecation.
- Rectocele, enterocele, sigmoidocele. With rectocele, the rectum protrudes into the vagina. With enterocele, the peritoneum and small intestine protrude. With sigmoidocele, the peritoneum descends to the pelvic floor, while the loops of the small or large intestine exert pressure on the rectum, which makes defecation difficult.Diseases appear as a result of physical exertion, due to obesity or after a difficult birth. At the same time, the patient suffers from constipation, pain and bleeding.
- Megarectum (significant expansion of the rectum at the level of the distal fragment of the sacrum) A number of reasons can lead to the expansion of the rectum. Often the source of megarectum is severe inflammation, a complication of ulcerative colitis or nerve damage. However, in some cases, the expansion of the rectum occurs due to a mechanical obstacle, including the fault of the tumor.To identify the causes of megarectum, a rectal examination is performed by radiography. The procedure allows you to make a diagnosis in a timely manner and, if necessary, prescribe an operation.
- Rectal invagination. Rectal invagination (rectal invagination) is called intestinal obstruction, in which one part of it is embedded in another. The anomaly may occur as a result of severe constipation or severe stress during defecation. Radiography of the rectum during rectal intussusception helps to localize the anomaly and plan the operation.
- Anismus. Dyssenergic defecation or anismus occurs due to the inability to completely relax the external sphincter and pelvic floor muscles when straining during defecation. The disease can lead to constipation and loss of the patient’s ability to empty the intestines independently. Usually, an X-ray of the rectum is performed after an anorectal manometry is done, or instead of it. The examination allows you to clarify the diagnosis and identify possible complications. For example, the formation of faecal matter. If the anomaly is not detected in time and treatment is not carried out, serious consequences may occur, including fecal incontinence.
- Intestinal obstruction. In almost 4% of cases, emergency surgery in abdominal surgery is required due to intestinal obstruction. The symptom can manifest itself in various diseases and almost always requires surgical treatment. For the effectiveness of the intervention, it is necessary to diagnose the disease correctly, and most importantly in a timely manner. Therefore, at the first signs of intestinal obstruction, a specialist prescribes a number of examinations. Including intestinal proctography.
In order to properly prepare for defectography, you need to clearly understand what intestinal proctography is and how it is carried out. During the examination, the intestine is filled with a contrast agent, so the patient needs to empty it before the procedure.
Two hours before the procedure, two cleansing enemas are made with an interval of 15 minutes. Starting from this time, the patient should not take food or medications. Immediately before the defectography, a thick mixture of barium and starch is injected into the patient’s rectum, this is the final stage of preparation. For the procedure, the doctor uses a syringe with a nozzle in the form of a plastic tube. Up to 250 ml of contrast agent is injected. In female patients, contrast can sometimes be injected into the vagina.
In order for the proctography to have the best effect, it is better to start preparing for the examination 2-3 days before the procedure. During this period, you should adhere to a slag-free diet and give up fried and fatty foods, fresh vegetables and fruits, coffee, bread, legumes, milk and other products that promote gas formation. On the eve of intestinal proctography, it is recommended to take 30 g of castor oil and make a cleansing enema. It is not recommended to have dinner before defectography.
Methods of conducting
Such an examination as an X-ray of the rectum is done under the supervision of a doctor. The specialist uses a special syringe to fill the patient’s rectum with a thick suspension of contrast agent, after which an X-ray is used. The pictures are taken during the bowel movement. The procedure is usually painless for the patient. Therefore, intestinal proctography is performed without anesthesia.
The examination is generally harmless to the patient. However, defectography has some contraindications. The examination is not performed for perforation of the colon wall and for patients in serious condition. In addition, intestinal proctography has contraindications common to all X-ray examination methods: pregnancy and age up to 15 years.