الفهرس 
meter and its relation to chronic constipation
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Abstract
defecation syndrome is a highly prevalent condition that has a significant impact on patients quality of life. The levator ani through its tonic activity stabilizes the abdominal and pelvic organs on one hand and controls the opening and closing of the levator hiatus on the other hand, The levator hiatus is the largest potential hernial portal in the human body. Excessive distensibility is associated with obstructed defecation syndrome (ODS)
Aim of work: to assess levator hiatus diameter and its relation to obstructed defecation by MRI defocography and trans rectal ultrasound
Methods :is a type of observational study used to look at factors associated with diseases. This case control study was conducted upon forty five persons; they were divided into two groups. 30 patients had obstructed defecation syndrome as a case group, the other 15 were normal as a control group. Patients were enrolled from outpatient clinics of General surgery department, Kasr El Aini hospital, Faculty of medicine, Cairo University, all patients were examined clinically and were assessed using renzi scoring system for obstructed defecation and then levator haitus diametr at maximal straining was measured by MRI defocography and trans rectal ultrasound .
Results :Results showed that the mean age of the cases was 45.83±11.67 . females were 73.3% .Levator hiatus diameter showed insignificant relation with intussuception , rectocele , UB descent or uterine descent . it also showed that there is week positive correlation between levator hiatus diametr and levator plate angle while moderate positive with iliococcygeus angle degree . it aslo showed that there is moderate positive correlation between levator hiatus diameter and Renzi scoring system for obstructed defecation and the mean diameter of levator hiatus diameter in the control group was 4.25±0.42. it also showed that the ability of the MR defecography and US to discriminate between patient with obstructed defecation versus control group in levator hiatus measure were excellent however the MR is more powerful to discriminate (AUC 0.942in MR while 0.938 in US). Also we managed to grade severity of obstructed defecation in relation to levator hiatus .
Conclusion : Finally we concluded that Assessment of the levator hiatus diameter by MR defocography and trans rectal ultrasound in relation to the severity of obstructed defecation will help in the management of ODS. As the severity of obstructed defecation increases along with levator hiatus diameter the management varies from medical treatment to levator muscle exercise and electrical stimulation to the surgical management like levatorplasty.