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Management of pelvic floor disorders affecting defecation

Medical and surgical management of pelvic floor disorders affecting defecation

News image

Pelvic floor disorders that affect stool evacuation include structural and functional disorders.

Meticulous history, digital rectal examination, and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion, and imaging studies such as anal ultrasound, defecography, and static and dynamic magnetic resonance imaging can facilitate an objective diagnosis and optimal treatment.
 
Dr Ron Schey & colleagues from Iowa, USA reviewed the management of pelvic floor disorders affecting defecation.
Biofeedback therapy is effective in treating dyssynergic defecation
American Journal of Gastroenterology
 
The researchers reported that management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and finally surgery.

Randomized clinical trials have established that biofeedback therapy is effective in treating dyssynergic defecation.
 
The team found that because dyssynergic defecation may coexist with conditions such as solitary rectal ulcer syndrome and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed.
 
Dr Shey's team concludes, "Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic, and transabdominal approach, stapled transanal rectal resection, and robotic colon and rectal resections."

"However, there is lack of well-controlled randomized studies and the efficacy of these surgical procedures remains to be established."

Am J Gastroenterol 2012; 107:1624–1633

26 November 2012

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