[Descending perineum syndrome: iatrogenic or spontaneous pathology?].

Among the causes of constipation, there is an infrequently recognised condition called descending perineum syndrome. This pelvic floor dysfunction causes a rectal tone disorder, and the clinical features include excessive and frequent straining and incomplete evacuation. Electrophysiological studies have shown a pelvic neuropathy in incontinent patients with descending perineum. The aetiological agents have been identified as follows: greater parity, dystocias and obstinate constipation, particularly if caused by expulsion difficulty. It has been observed that pelvic floor surgery may have physiopathological consequences that bring on the onset of dynamic disorders. The diagnosis may present difficulties and failure to identify the syndrome leads to inadequate and repetitive treatment of no real benefit to the patient. Since it is impossible to correct the excessive descent of the pelvic floor, the treatment will be aimed at resolving the predominant symptom in relation to the physiopathological factors causing it.