Background: obstructed defecation is one of the most common subtypes of constipation, and it is frequently responsive to biofeedback treatment.Aims: since a history of sexual and physical abuse may be present in patients with obstructed defecation, we assessed the incidence of abuse history in patients with obstructed defecation referred to a general gastroenterology practice, and whether such a history may lead to a different outcome of biofeedback training in these patients.Patients and methods: one hundred and twenty-one patients (17 men, 104 women, age 53 ± 15 years) with obstructed defecation were studied by retrospective chart review. Their history of sexual, physical and psychological abuse was obtained by a standard interview, and biofeedback training was carried out by means of a three-balloon technique.Results: a history of sexual/physical or psychological abuse was present in 12.4% patients. Biofeedback training yielded a successful improvement of obstructed defecation in 93% patients without abuse and in 100% of patients with abuse; this difference was not statistically different (p = 0.53).Conclusions: the prevalence of sexual/physical or psychological abuse in a population of patients with obstructed defecation referred to a general gastroenterology practice is relatively low; such a history seems not to affect the outcome of biofeedback training in these patients.Key words: Abuse. Biofeedback. Constipation. Obstructed defecation. INTRODUCTIONChronic constipation is a frequent complaint in clinical practice, and affects 3 to 30% of the general population in Western countries, particularly women (1). However, recent studies have shown that similar figures are also present in other countries, such as Latin America (2).The pathophysiological basis of chronic idiopathic constipation may basically be reconducted to two main subtypes, slow-transit constipation (STC) and constipation due to obstructed defecation (OD) (3). The latter, after excluding anatomical or mechanical causes, may be often due to paradoxical contraction or failure to relax of the pelvic floor muscles during attempts to defecate, which impedes the outflow of feces (4,5).The prevalence of OD in different series varies between 25 and 70% (6,7). This probably reflects different population samples, with a prevalence of 7% in the general population (8). In many of these patients biofeedback treatment is very effective (9,10).Even though behavioral or psychological disturbances are frequently encountered in OD, it is still controversial whether these abnormalities are the cause or the consequence of this often disabling symptom (11).Physical and/or psychical abuse are described with relative frequency in some functional gastrointestinal disorders, particularly in patients with irritable bowel syndrome (IBS) (12,13); less data are available for constipated, non-IBS patients. Two recent studies reported that more than 32% of patients with OD had a history of physical and/or psychical abuse (14,15). However, no data on the treatment of such pa...

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Obstructed defecation is one subtype of constipation, and may be due to functional or mechanical causes. Here, we report an unusual cause, never described before, of obstructed defecation due to a large uterine myoma that reverted to normal bowel habits after surgery. The importance of an accurate evaluation of the causes of constipation is highlighted, to recognize potential curable factors.

Introduction. Endoscopic Full-thickness Resection (EFTR) consists of the full-thickness resection of a limited portion of the digestive wall immediately followed by defect closure. This technique has been proposed for the resection of selected lesions not amenable to conventional endoscopic resection. Objective. The aim of this work is to describe the first three cases of colonic EFTR performed in Argentina. Material and methods. Three patients are described, one with a laterally spreading tumor of approximately 35-40 mm (n = 1) and two with an incomplete adenoma resection with a scar and a non-lifting sing (n = 2). After tumor delineation using a marking probe, EFTR was performed using the full thickness resection device (FTRD, Ovesco, Germany). Antibiotic prophylaxis was prescribed, abdominal plain film was performed 5 hours after the procedure and hospital discharge was granted after twenty four hours. Results. The resection of the lesions was macroscopically complete and no signs of perforation or significant bleeding were detected. Histopathological examination confirmed the complete resection of a tubulovillous (n = 2) and a tubular (n = 1) adenoma, all with high-grade dysplasia. No complications were detected during the follow up. Conclusion. It was concluded that the EFTR is an innovative technique that was effective and safe used in this small series of patients as an alternative to surgery.