Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Abstract

-Context -Management of patients with obstructed defecation syndrome is still controversial. Objective -To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. Methods -The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. Results -Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associa ted with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. Conclusions -Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts. HEADINGS -Rectocele. Constipation. Pelvic floor. Imaging, three-dimensional.None disclosure.

A New Dynamic Echodefecography (EDF) Established by Using BK Ultrasound 8838 Transducer and its Testing Results Comparison with X-ray Defecography

“…The EDF can show clear floor muscle and anatomic structure and is considered as an ideal method to diagnose the pelvic floor diseases compared with X-ray defeography. [10][11][12][13][14] . Xue et al [15] used EDF to study functional anal pain.…”

Obstructed Defecation Syndrome: A Treatise on Its Functional Variant

“…On physical examination, the paradoxical contraction of the pelvic floor can be assessed by palpation of the puborectalis muscle while the patient is straining [27]. Perineal descent >3 cm, mucous discharge or mucosal prolapse may also be seen when the patient is asked to strain for stools [28]. However, most clinicians do not rely on palpation and advocate the use of specific tests to diagnose ODS [28][29][30][31][32].…”

“…Perineal descent >3 cm, mucous discharge or mucosal prolapse may also be seen when the patient is asked to strain for stools [28]. However, most clinicians do not rely on palpation and advocate the use of specific tests to diagnose ODS [28][29][30][31][32]. Electromyography (EMG) of the pelvic floor, the balloon expulsion test (BET), and defecography are the most frequently used tests [30][31][32][33].…”

“…Electromyography (EMG) of the pelvic floor, the balloon expulsion test (BET), and defecography are the most frequently used tests [30][31][32][33]. Other radiologic methods for the dynamic evaluation of the ODS include magnetic resonance imaging and ultrasonography, each of which has its advantages and limitations [28][29][30][31][32][33][34].…”

“…In EMG, the activity of the pelvic floor is measured with a needle or wire electrode, inserted in the puborectalis muscle, with the patient in left lateral position. In pelvic dys-synergy, EMG shows a paradoxical increase in activity of the puborectalis muscle during straining [28][29][30][31]. In BET, the patient is asked to expel is a balloon filled with air or water is installed in the rectum, after positioning him in the left lateral or sitting position.…”