Pelvic floor dysfunction is a common cause of functional constipation; its diagnosis requires anorectal physiological tests that are not  widely  available.  Ultrasound  imaging  has  been  established  as  an  appropriate  method  for  visualizing  and measuring  pelvic  floor  (PF) mobility.  No  study  has  directly  evaluated  PF mobility in  individuals  with  and without functional  constipation.  The  purpose  of  this  study  was  to  investigate  the  PF mobility in  women  with  and  without  functional constipation using ultrasound.

A convenience sample of 40 non-pregnant female participated in the study. Subjects were categorized into 2 groups: those with functional constipation (n= 20) and those without functional constipation (n= 20). The subjects with functional constipation had been claimed by a proctologist to have symptoms of functional constipation. The subjects were asked to perform two tasks: (1) pelvic floor muscle contraction and (2) maximal straining Valsalva maneuver. A diagnostic ultrasound imaging unit set in B-mode (Ultrasonix-ES500, Burnaby, B.C., Canada) with a 3.5-MHz curved (convex) array transducer was used for ultrasound measurement. The amount of bladder base displacement was measured using ultrasound in all subjects and considered as an indicator of pelvic floor mobility.

Reliability coefficients ranged between 0.73 to 0.94 for two tasks. It indicates high intra-tester reliability for the ultrasound measurements.
Statistical analysis (Independent t-test) revealed no significant difference in ultrasound measurements for pelvic mobility during both tasks (pelvic floor muscle contraction (P=0.79) and Valsalva maneuver (P=0.63)) between the two groups.

Real-time ultrasound  imaging has been  recently  established  as  a  method  to assess muscle  structure, mobility,  and  activation patterns.  Ultrasound  is  frequently  used  to  evaluate  the  pelvic floor mobility during voluntary  muscle  contraction  or  automatic  muscle  function  at  the unconscious level. However, what we measured in this study was a voluntary contraction and not the automatic recruitment during functional tasks.
In this study, the probe was transversely placed on the suprapubic region. The value of this technique is that it allows for visualization of both sides of the pelvic floor at once and any pressure by the ultrasound probe against the abdominal wall, and movement of the abdominal wall, is dissipated by the fluid-filled bladder and provides feedback regarding correct contraction.

It seems that female with functional constipation have no significantly decreased pelvic floor mobility compared with those with functional constipation.
In the present study, the severity of constipation was not determined and women with constipation were not classified to mild and severe. We suggest that this study could be done on the healthy women and subjects with different type of constipation to provide more insight regarding the pelvic floor mobility in women with and without constipation.

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