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

AbstractCONTEXT:
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, associated 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.
AuthorsSthela Maria Murad-Regadas, Francisco Sergio P Regadas, Lusmar Veras Rodrigues, Graziela Olivia da Silva Fernandes, Guilherme Buchen, Viviane T Kenmoti
JournalArquivos de gastroenterologia (Arq Gastroenterol) 2012 Apr-Jun Vol. 49 Issue 2 Pg. 135-42 ISSN: 1678-4219 [Electronic] Brazil
PMID22767001 (Publication Type: Journal Article)
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Constipation (diagnostic imaging, therapy)
  • Female
  • Humans
  • Intussusception (diagnostic imaging, therapy)
  • Middle Aged
  • Pelvic Floor (physiopathology)
  • Rectal Diseases (diagnostic imaging, therapy)
  • Rectocele (diagnostic imaging, therapy)
  • Severity of Illness Index
  • Syndrome
  • Treatment Outcome
  • Ultrasonography

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