Defecography

What is defecography?

Defecography is an examination that records a patient defecating a thick, stool-like barium paste. This is a dynamic examination recorded on videotape or digital video disc (DVD) recorder. Defecography is also known as voiding proctography and is often performed in conjunction with cystography.

What types of symptoms are indications for defecography?

Patients complaining of incontinence, painful defecation, incomplete defecation, or constipation may benefit from defecography.

What happens to a patient during defecography?

The patient, if a woman, ingests a moderate volume of barium (500 mL) to opacify the small intestine. If the patient is a woman, a small amount (3-5 mL) of thick barium is instilled into the vagina to opacify the vagina. A tiny lead marker (e.g., a metallic nipple marker used in chest radiography) is placed on the perineal body. Thick barium paste that mimics soft, formed stool is instilled into the rectum. The patient then sits on a commode and defecates. The radiologist takes images before, during, and after defecation. The images show the relationships between the small bowel, vagina, and rectum during defecation.

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What abnormalities are detected during defecography that are not identified during endoscopy or barium enema?

Defecography can show rectocele, enterocele, abnormal anal sphincter opening, abnormal “relaxation” of the puborectalis muscle of the pelvic floor, abnormal rectal contraction, and varying degrees of prolapse of the rectal or anal tissue either through the anal canal or through the vagina 

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