Methods of Evaluation of Anorectal Causes of Obstructed Defecation

Abstract

Obstructed defecation is a complex disorder that results in impaired propagation of stool from the rectum. It is one of the major subtypes of functional constipation and can be secondary to either functional or anatomic etiologies. Patients with obstructed defecation typically present with symptoms of abdominal discomfort, a sensation of incomplete evacuation and rectal obstruction, passage of hard stools, the need for rectal or vaginal digitation, excessive straining, and reduced stool frequency. Evaluation of obstructed defecation is multimodal, starting with a thorough history and physical examination with focus on the abdominal, perineal, and rectal examination. Additional modalities to elicit the diagnosis of obstructed defecation include proctoscopy, colonic transit time studies, anorectal manometry, a rectal balloon expulsion test, defecography, electromyography, and ultrasound. The results from these studies should be taken in the context of each patient's clinical situation, as there is no single criterion standard for the diagnosis of obstructed defecation. Surgery is typically a last resort for these patients and the majority of patients will have good symptomatic management with diet and lifestyle changes. Patients who are found to have functional mechanisms behind their obstructed defecation also benefit from pelvic floor exercises and biofeedback therapy.

Trastornos funcionales de la evacuación. Una revisión

“…Estos hallazgos sugieren que la evaluación de la PEB en la posición sentada probablemente sea suficiente para identificar un TFE en la mayoría de los pacientes. Sin embargo, entre los pacientes con un alto índice clínico de sospecha de TFE, pero una PEB normal en posición sentada, se debe considerar la evaluación de la PEB en la posición lateral izquierda (particularmente en aquellos con excesivo descenso perineal) 21,23 .…”

“…Se simplificó la evaluación de los cuatro tipos de TFE, identificando solamente tres fenotipos, durante la evaluación del pujo: fenotipo 1, alta presión en conducto anal; fenotipo 2, baja presión intrarrectal y fenotipo 3, un híbrido con baja presión intrarrectal y falta de relajación del conducto anal. Estos fenotipos pueden discriminar pacientes con PEB normal y anormal con un 75% de sensibilidad y un 75% de especificidad 21,33 .…”

Clinical, endoscopic and radiological assessment of patients with obstructed defecation: findings and management at a District General Hospital

“…2 OD is characterised by infrequent bowel motions, incomplete stool evacuation despite frequent visits to the toilet, urgency to open bowels, manual evacuation, need to selfdigitate or put pressure on the perineum to help stool evacuation. 3 Feeling of pelvic heaviness, abdominal bloating and pain may also be associated features. Persistent straining to evacuate stools can in turn lead to ABSTRACT Background: The aim of the study was to determine the diagnostic value of clinical, endoscopic and proctographic assessment as well as clinical outcomes in patients with obstructed defaecation (OD).…”

Taisnās zarnas sienas klīniskās, biomehāniskās un morfoloģiskās īpatnības pacientiem ar obstruktīvās defekācijas sindromu. Promocijas darbs

“…Mērķtiecīgākas ir tieši uz iegurņa muskulatūru un saitēm vērstas aktivitātes: aerobika, pilates, ārstnieciskā vingrošana, intīmais fitness, skriešana un soļošana (Fabrizio, Alimi and Kumar, 2017;Rao, 2009;Sharma and Rao, 2017).…”

“…Pareizas koordinēšanās un darbības efektivitāti pacients vizuāli var kontrolēt monitorā ar dažādu grafiku un animāciju palīdzību (1.12. attēls)(Rao and Go, 2009). Taču biofīdbeka procedūras pārliecinoši labus rezultātus uzrāda tikai dissinerģiskas defekācijas gadījumā, izolētu lēna tranzīta aizcietējuma gadījumā šāda veida procedūras izrādījušās praktiski neefektīvas Konservatīvas terapijas efektivitāti var palielināt arī dažādi starpenes un iegurņa muskulatūru nostiprinoši vingrinājumi, kurus parasti arī rekomendē dissinerģisku aizcietējumu gadījumā(Fabrizio, Alimi and Kumar, 2017;Sharma and Rao, 2017). Šajos gadījumos pacientam tiek rekomendēta ārstnieciskā vingrošana, aerobika, pilates, skriešana u.c.…”