Obstructed Defecation Research Articles

Obstructed defecation syndrome in the first week after pelvic reconstructive surgery.

Research shows that patients are concerned about postoperative bowel function after pelvic reconstructive surgery. The objectives of this study were to estimate the proportion of patients with obstructed defecation syndrome (ODS), a subtype of constipation, in the week after surgery, to identify associated patient-level and perioperative characteristics and the associated bother. Women completed a preoperative and postoperative ODS questionnaire and postoperative bowel diary. Characteristics of women with and without postoperative ODS were compared. Chi-squared or Fisher's exact tests compared categorical variables. Student's t test or Wilcoxon rank-sum tests compared continuous variables. Multivariate logistic regression was assessed for independent effects. Wilcoxon rank-sum tests compared the groups with regard to bother. Spearman correlation coefficients described the relationship among bother, postoperative ODS score, and bowel diary variables. Of the 186 participants enrolled, 165 completed the postoperative ODS questionnaire. Of these, 39 women (23.6%, 95% CI 17.2-30.1) had postoperative ODS. Postoperative ODS was significantly associated with preoperative ODS (p < 0.001), posterior colporrhaphy (p = 0.03), surgery type (p = 0.01), and longer duration of surgery (p = 0.03). Using multivariate logistic regression controlling for age, only preoperative ODS was significantly associated with postoperative ODS (OR 2.68, 95% CI 1.73-4.17). Women with postoperative ODS reported more bother with their defecatory symptoms (p < 0.001). The degree of bother was significantly associated with postoperative ODS score (p < 0.001). Using a validated disease-specific questionnaire to identify ODS, this complication was identified in 23.6% of patients in the week after pelvic reconstructive surgery. Preoperative ODS was a significant and important risk factor for this complication.

Magnetic Resonance Defecography in Obstructive Defecation Syndrome: A Pictorial Review Imaging Findings and Impact on Surgical Management

AbstractPelvic floor, a funnel-shaped muscular structure plays a significant role in bowel and bladder activities. Defecatory disorders result from the structural changes and functional disorders. Pelvic floor dysfunction affects 15% of multiparous women. It is being expected that after 30 years, there would be 45% rise in demand of pelvic floor imaging. After ruling out primary and secondary causes of constipation, diagnosis of obstructed defecation syndrome (ODS) is made. ODS is emerging as one of the important causes of constipation. As the symptoms are nonspecific and examination findings are frequently inaccurate, the clinical evaluation becomes a difficult task. Hence, various imaging modalities are becoming popular as an adjunct tool for the assessment of these disorders. Clinical management of ODS is based on the Constipation and Bowel Activity Score (CABA) and delineation of the pelvic floor anatomy. After defining the pelvic floor anatomy–based structural abnormality, day care ambulatory surgical procedure, that is, stapled transanal resection rectopexy (STARR), is offered to the patients of ODS. It provides significant relief to patients suffering from constipation and reduction in postoperative CABA score. This review discusses the role of magnetic resonance defecography imaging in ODS its impact on subsequent management.

Early functional outcomes of laparoscopic ventral mesh rectopexy in obstructed defecation syndrome: Case series

Early functional outcomes of laparoscopic ventral mesh rectopexy in obstructed defecation syndrome: Case series

Инкоботулотоксин А в детской колопроктологии. Первый опыт применения в России

In the last decade, botulinum toxin type A (BTA) has been used in children with colorectal diseases. There are no published papers on the topic in Russia. Objective. To investigate BTA effectiveness in children with different colorectal problems. Patients and methods. 9 patients from 1.7 to 14 years old (median age 3.5 years) were treated with the new method in the Speransky Children's Hospital (Moscow, Russia). The indications for treatment were various complaints (constipation, fecal pseudo-incontinence, painful defecation, obstructive defecation), anal hypertonia (spasm). We treated children in whom conservative therapy was ineffective. Incobotulinumtoxin A was administered under general anesthesia at a dose of 3–6 U/kg at 4 points along the circumference of the anal canal. Results. The effect of therapy was obtained in 7 out of 9 patients (77.8%). A good and excellent result was recorded in 4 patients (44.4%), mild – in 3 (33.3). There was no effect in two children with genetic pathology and Hirschsprung's disease with colostomy (22.2%). Conclusion. Circumferential chemodenervation with incobotulinumtoxin A of anal sphincters is an effective and safe method of treating children with defecation disorders resistant to routine conservative therapy, but further research is needed to develop patient selection, dose calculation and create guidelines injection technique and its frequency. Key words: dyssynergic defecation, painful defecation, hirschsprung, achalasia, incobotulinumtoxin A, children

Rectal Evacuation Disorders in Patients Presenting With Chronic Functional Diarrhea.

Defecatory disorders include a spectrum of conditions that manifest as spastic rectal evacuation disorders or flaccid disorders causing obstructed defecation.1 Functional defecation disorders are usually evidenced by 2 of the following 3 tests documenting impaired evacuation: abnormal balloon expulsion test, abnormal anorectal evacuation pattern with manometry, or impaired rectal evacuation by imaging. Descending perineal syndrome is defined by at least 4-cm caudal movement of the anorectum upon defecation with a failure of rectoanal angle opening, outlet obstruction, and incomplete defecation.

Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

Value of Defecography in the Diagnostic and Therapeutic Management of the Modified Wells Procedure for Rectal Prolapse.

The main aim of this study was to explore the role of defecography in the preoperative diagnosis and postoperative evaluation of rectal prolapse surgery (modified Wells procedure). We collected and summarized the X-ray performance and then analyzed the results of 107 patients with defecatory dysfunction who underwent defecography from January 2020 to March 2021. Furthermore, the preoperative and 6-month postoperative defecography results and clinical symptoms of 25 patients who underwent rectal prolapse surgery (modified Wells procedure) were compared. Results showed that among the 107 patients with defecation dysfunction, women had worse defecography results than men (P < 0.01). A total of 25 patients successfully completed the surgery without complications such as infection and intestinal fistula and there was no recurrence at 12 months of follow-up. Compared with the preoperative results, anorectal angle during defecation, the depth of rectocele, and perineal descent were significantly improved after the surgery (P < 0.01). Moreover, the patient's feeling of obstructed defecation and incomplete defecation was significantly relieved compared to that before the procedure (P < 0.01). In conclusion, defecography can be used to diagnose rectal prolapse preoperatively and evaluate the surgical effect combined with clinical symptoms postoperatively, which provides a clinical reference.

Evaluation of Anorectal Function in Perianal Crohn's Disease: A Pilot Study.

Background: Perianal Crohn’s disease is a disabling condition, with little known about anorectal function in healed/inactive perianal Crohn’s disease; Aim: To evaluate anorectal function in a cohort of patients with treated/healed perianal Crohn’s disease; Methods: Prospective cohort study, including high-resolution anorectal manometry, balloon expulsion test, and 3D-endoanal ultrasound in all patients; Results: Of the 16 patients studied (mean age ± SD, 42 ± 13 years), 12 (75%) were men. A laceration of the internal anal sphincter and/or anal scarring was seen in nine (56%) patients; there was no laceration of the external anal sphincter. Five (56%) of these nine patients had never experienced faecal incontinence. All had normal anal resting and squeeze pressures. Manometry suggested dyssynergia in 11 (69%) patients, with only one (6%) fulfilling the criteria for obstructed defecation. Hyposensitivity for at least one sensory parameter was seen in 11 (69%) patients and hypersensitivity in five (31%) patients; Conclusions: This study detected sphincter abnormalities in more than half of patients, many of whom were asymptomatic. Alterations in rectal sensation were frequently seen, more commonly with rectal hyposensitivity. Trial registration: ClinicalTrials.gov (NCT03819257).

Does Rectocele Repair Combined with Other Perineal Surgeries Affect Outcome Compared to Solo Rectocele Repair?

Objectives: Rectocele is common in female patients. To date, there is no literature comparing outcomes of rectocele repairs in combination with other perineal surgeries. We aim to analyze perioperative morbidity and mortality as well as long-term outcome of rectocele repair in combination with other perineal surgeries (RR combination) and compare this with solo rectocele repair (solo RR). Design: The type of study was case-control. Data of patients who received solo rectocele repair or rectocele repair in combination with other perineal surgeries between January 2011 and December 2015 were identified and reviewed in a prospectively maintained and IRB-approved database. Ninety-eight patients were included, including 41 patients in the solo RR group and 57 patients in the RR combination group. The demographics, characteristics of patients, short-term complications, long-term complications, and morbidity of the 2 groups were observed. Methods: The demographics, characteristics of patients, short-term complications, long-term complications, and morbidity of the 2 groups were compared, respectively. Covariate adjustment was analyzed by multivariate logistic and Cox regression analysis. Results: Ninety-eight patients with a median age of 57 were included, involving 41 patients in the solo RR group and 57 patients in the RR combination group. Other than the operative approach (p < 0.01), demographics and preoperative characteristics of the 2 groups were comparable. All variables, including length of stay, estimated blood loss, self-limiting rectal bleeding, transfusion, urinary retention, rectal stricture, rectal and perineal infection, rectovaginal abscess, reoperation, effective resolution of obstructive defecation symptoms, residual symptoms rate, and recurrence rate, were comparable among the 2 groups except for operative time (p = 0.03). Limitations: This study is a single-center study, which may cause bias. In addition, the sample size is limited. Staging of rectocele and routine imaging studies were not performed. Conclusions: Rectocele repair in combination with other perineal surgeries is feasible, and outcomes are comparable with solo rectocele repair. Transanal versus transvaginal repairs appear to have no influence on outcomes.

Ventral Prosthesis Rectopexy for obstructed defaecation syndrome: a systematic review and meta-analysis.

Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. However, the selection criteria of patients to undergo this kind of operation are not clear and the reported outcomes are mainly short-term and data on long-term outcomes is scarce. This study assesses new evidence on the efficacy of VPR for the treatment of ODS, specifically focusing on inclusion criteria for surgery and the long-term outcomes. A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VPR for ODS from 2000 to March 2020. No language restrictions were made. All studies on VPR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Fourteen studies including 963 patients were eligible for analysis. The immediate postoperative morbidity rate was 8.9%. A significant improvement in constipation symptoms was observed in the 12-month postoperative period for ODS (p < 0.0001). Current evidence shows that VPR offers symptomatic relief to the majority of patients with ODS, improving both constipation-like symptoms and faecal incontinence for at least 1-2years postoperatively. Some studies report on functional results after longer follow-up, showing sustainable improvement, although in a lesser extent.

Transperineal rectocele repair is ideal for patients presenting with fecal incontinence.

Rectocele can be associated with both obstructed defecation and fecal incontinence. There exists a great variety of operative techniques to treat patients with rectocele. The purpose of this study was to evaluate the clinical outcome in a consecutive series of patients who underwent transperineal repair of rectocele when presenting with fecal incontinence as the predominant symptom. Twenty-three consecutive patients from April 2000 to July 2015 with symptomatic rectocele underwent transperineal repair by a single surgeon. All patients had a history of vaginal delivery, with or without evidence of associated anal sphincter injury at the time. The median age of the cohort was 53 years (range, 21-90 years). None were fully continent preoperatively. However, continence improved to just rare mucus soiling or loss of flatus in all patients 6 months after their surgery. There was no operative mortality. Postoperative complications including urinary retention and wound dehiscence occurred in 3 patients. Fecal incontinence associated with rectocele is multifactorial and may be caused by preexisting anal sphincteric damage and attenuation. Our experience suggests that transperineal repair provides excellent anatomic and physiologic results with minimal morbidity in selected patients presenting with combined rectocele and anal sphincter defect.

Correlation between Nidana (etiological factors) and symptoms of Purishavaha Strotodushti - A cross sectional survey study

Introduction: Strotasa a unique concept explained in Ayurveda are the channels (micro/macro) through which constituents for nourishment of Sharira bhava(body constituents)are constantly circulated. Functioning of Purishvaha Strotasa (channels for feces transportation and transformation) deals with the formation, retention and evacuation of feces. Symptoms caused by vitiation of Purishvaha Strotasa are primarily concerned with defecation. For prevention and treatment of diseases related to Purishvaha Strotasa one must account for Nidana(causative factors) those vitiates the Strotasa. Aim of study: To survey correlation if any between causative factors stated for vitiation of Purishvaha Strotasa and symptoms of Purishvaha Stroto dushti observed in patients. Material and methods: A cross sectional survey was carried out on 120 patients suffering from vitiation of Purishvaha Strotasa above age of 60 years irrespective of sex, religion and diet pattern. Patients were surveyed with help of questionnaire designed to evaluate Strotasa Parikshana (examination), Nidana for Purishvaha Stroto dushti. Observation and results: 66.66% of participants had mixed type of diet, 95% of patients had passage of sticky foul smelling stool. Bristol Stool Chart observations revealed80 % of patient were having hard stool. All (100%) patients had modified ODS (Obstructive Defecation System) Longo score more than 16. One or more causative factors stated in Charaka Samhita for vitiation of Purishvaha Strotasa were observed in all surveyed patients with Purishvega Sandharana- suppression of an urge to defecate (66.66%) and Adhyashana– overeating when previous food is undigested (62.5%)being more prevalent. Conclusion: Outcome of study asserts a strong correlation between Nidana (etiological factors) and symptoms of Purishvaha stroto dushti.

Primary diffuse large B-cell lymphoma of the sigmoid colon.

IntroductionExtranodal lymphomas are commonly encountered in the gastrointestinal tract but lymphomas of colon and rectum are rare. Non-Hodgkin lymphoma is the most common type of colonic lymphoma and represents less than 0.5% of colorectal neoplasms. Chemotherapeutical agents are gateway to disease remission and sometimes cure in most patients but surgery may be necessary in emergent situations.Case presentationA 77-year-old male patient presented with abdominal discomfort, constipation, and obstructive defecation symptoms. Radiological imaging revealed a mass in the sigmoid colon extending towards the rectum. Colonoscopy was performed and biopsy of a nearly 10 cm ulcerovegetative lesion was obtained. Histological examination following biopsy revealed it to be a diffuse large B-cell lymphoma of the sigmoid colon. There was no indication for surgery and the patient was referred to medical oncology clinic for chemotherapy treatment.DiscussionNon-Hodgkin lymphoma is a lymphoproliferative disorder with the diffuse large B cell lymphoma (DLBCL) being the most common subtype. The DLBCL subtype is rarely observed in the colon and rectum. Chromosomal abnormalities are involved in the pathophysiology and gene rearrangements lead to adjustments in lymphocyte function and differentiation.ConclusionIn this case report, we present a rare presentation of a Non-Hodgkin lymphoma presenting in the sigmoid colon. The disease can present with nonspecific symptoms and various imaging modalities along with histopathological evaluation is necessary for the correct subtyping of lymphoma. Chemoradiotherapy is key for treatment, and surgery is usually reserved for cases of obstruction, perforation, or bleeding.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

Relation between pelvic floor neurophysiological abnormalities and erectile dysfunction in patients with obstructed defecation

BackgroundObstructed defecation is a common pelvic floor medical problem among adult population. Pelvic floor disorders were reported to be associated with sexual dysfunction including erectile dysfunction among male patients. The aim was to determine the relation between pelvic floor neurophysiological abnormalities and erectile dysfunction in male patients with obstructed defecation.MethodsThis cross-sectional study included 65 married male patients with obstructed defecation and a control group consisted of 15 apparently healthy married males. Assessment of obstructed defecation severity was done by using modified obstructed defecation score, time of toileting and Patient Assessment of Constipation-Quality of Life questionnaire. Assessment of erectile functions was done using erectile function domain of International Index of Erectile Function questionnaire and Erectile Dysfunction-Effect on Quality of Life Questionnaire. Anal manometry and dynamic pelvis magnetic resonance imaging were done. Electrophysiological studies included pudendal nerve motor conduction study and needle electromyography of external anal sphincter, puborectalis and bulbocavernosus muscles.ResultsThere were 32 patients (49.2%) who had erectile dysfunction. The maximum straining anal pressure was significantly higher among patients with erectile dysfunction. Pudendal nerve terminal motor latency was significantly delayed and the percentage of bilateral pudendal neuropathy was significantly higher among patients with erectile dysfunction. The percentage of electromyography evidence of denervation with chronic reinnervation in the external anal sphincter and bulbocavernosus muscles were significantly higher among patients with erectile dysfunction. Regression analysis detected three co-variables to be associated with significantly increasing the likelihood of development of erectile dysfunction. These were maximum straining anal pressure (odd ratio = 1.122), right pudendal nerve terminal motor latency (odd ratio = 3.755) and left pudendal nerve terminal motor latency (odd ratio = 3.770).ConclusionsErectile dysfunction is prevalent among patients with obstructed defecation. It is associated with characteristic pelvic floor electrophysiological abnormalities. Pelvic floor neurophysiological changes vary from minimal to severe neuromuscular abnormalities that usually accompanying erectile dysfunction. Pudendal neuropathy and increased maximum straining anal pressure are essential risk factors for increasing the likelihood of development of erectile dysfunction in patients with obstructed defecation.

CORRELATION BETWEEN PELVIC FLOOR DYSFUNCTION ON DYNAMIC 3D ULTRASOUND AND VAGINAL DELIVERY, PARITY, AND AGE IN WOMEN WITH OBSTRUCTED DEFECATION SYMPTOMS.

Few studies have investigated the constipation or obstructed defecation symptoms identified by using imaging, as dynamic three-dimensional ultrasound and correlate vaginal delivery, parity, and age. The aim of this study was to assess the prevalence of pelvic floor dysfunctions in female patients with obstructed defection symptoms and to determine whether specific pelvic floor dysfunctions identified by dynamic three-dimensional ultrasonography (echodefecography) are correlated with vaginal delivery, parity, and age. The secondary goal is to report the prevalence of coexisting pelvic floor dysfunctions. This is a retrospective cohort study including patients with obstructed defecation symptoms underwent echodefecographyto evaluate pelvic floor dysfunctions in the posterior compartment and correlate with vaginal delivery, parity, and age. Of 889 female: 552 (62%) had had vaginal delivery and 337 (38%) were nulliparous. The prevalence of dysfunctions identified by echodefecography (rectocele, intussusception, enterocele/sigmoidocele, and dyssynergia) was similar between the two groups and was not associated with number of deliveriesor age. However, the prevalence of sphincter defects showed higher rates in women with vaginal delivery and increased with the parity. Up to 33% of patients had coexisting dysfunctions. The prevalence of dysfunctions such as rectocele, intussusception, dyssynergia, and enterocele/sigmoidocele assessed by echodefecography in patients with obstructed defecation symptoms are found similar regardless of vaginal delivery, number of deliveries or stratified-age. In vaginal delivery, number of deliveries does impact on detection of sphincter defects and liability to fecal incontinence.

Trends in the surgical management of rectal prolapse: An Asian experience.

Posterior compartment pelvic floor prolapse (PCPFP) leads to anatomical distortion and functional impairment. Definitive management involves surgery. Ventral mesh rectopexy (VMR) has gained increasing popularity in the West as it emerges as a durable approach. Existing literature and evidence on safety and efficacy of PCPFP surgery in the Asian population remains sparse. Our study aims to review our institution's experience in surgery for PCPFP. All cases of PCPFP surgery in Singapore General Hospital between 2014 to 2019 were studied. Eighty-three patients had surgery performed for PCPFP, with the majority (83%) in the last 3 years. Median age was 63 years and 92% were female. Most patients (64%) had obstructive defecation symptoms, while the remaining had fecal incontinence, rectal bleeding, or anal discomfort. Main anatomical indication for surgery was external rectal prolapse (48%). Other indications were rectocele and/or rectal intussusception. The majority (66%) had abdominal rectopexy, while 28 underwent Delorme's procedure. Forty-five of the 50 VMRs were minimally invasive. Patients undergoing rectopexy were observed to be younger. Median length of stay was 3 days. Nine patients had early operative complications of which ileus was most common. Median length of follow-up was 12 months. The majority (93%) had initial symptom satisfaction. Eleven patients had anatomical recurrence with a median length of 9months to development. There was no significant difference in outcomes between abdominal vs perineal approach, or laparoscopic vs robotic VMR. Surgery for PCPFP has gained acceptance in our Asian institution with good symptom improvement, alongside low morbidity and recurrence.

Does acupuncture have any effect on obstructed defecation syndrome?

Does acupuncture have any effect on obstructed defecation syndrome?

Laparoscopic Ventral Mesh Rectopexy with Resection of Dolichocolon for Treatment of Obstructed Defecation Syndrome: Technical Report

Laparoscopic Ventral Mesh Rectopexy with Resection of Dolichocolon for Treatment of Obstructed Defecation Syndrome: Technical Report

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

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). The study also examined correlation between clinical/endoscopic findings and proctogram in the diagnosis of rectocele and intra-rectal intussusception (IRI).Methods: Patients presenting with symptoms of OD between January-December 2018 were assessed with manual examination, endoscopy and defecation proctogram. Patients were followed for 2-3 years for clinical outcomes.Results: There were 65 female (97.01%) and 2 male patients (2.98%), with an average age of 57.77 (34-88) years. Main indications were OD, altered bowels, faecal urgency and rectal bleeding. A total of 67 X-ray defecating proctograms and 77 endoscopies were performed. Main findings on clinico-endoscopic examination were IRI (44), rectocele (36) and haemorrhoids (21). Main findings on proctogram were rectocele (59), IRI (56) and enterocele (13). Endoscopic assessment showed sensitivity: 55.93%, specificity: 62.50% and accuracy: 56.72% in diagnosing rectocele when compared with the diagnostic confirmation on proctogram. Combining manual assessment with endoscopic findings improved sensitivity (76.27%) and accuracy (68.66%). Similar improvement was also noted in the sensitivity (61.40 to 66.67%), specificity (47 to 58%), and accuracy (53.73 to 58.21%) in diagnosing IRI when compared with the diagnostic confirmation on proctogram. Majority of the patients improved with conservative measures; however, surgical intervention was required in 13 patients.Conclusions: Although manual examination enhances endoscopic assessment in diagnosing rectocele and IRI, proctogram is still required for objective assessment. Management of OD remains mainly conservative, with surgical intervention required in some patients.