Background
The indications for operation in patients with obstructed defecation syndrome (ODS)
with rectocele are not well defined.
Methods
A total of 90 female patients with ODS and rectocele were prospectively evaluated
and treated with fiber supplements and biofeedback training. Univariate and multivariate
regression was used to determine factors predictive of failing medical management.
Results
Obstructive symptoms were the most prevalent presenting complaint (82.2%). Ultimately,
71.1% of patients responded to medical management and biofeedback. Multivariate regression
analysis suggested that the presence of internal intussusception was associated with
a lower chance of undergoing surgery to address ODS symptoms [odds ratio 0.18; P = .05], whereas inability to expel balloon, contrast retention on defecography, and
splinting were not (P ≥ .15).
Conclusion
Rectoceles with concomitant intussusception in patients with ODS appear to portend
a favorable response to biofeedback and medical management. We argue that all patients
considered for surgery for rectoceles because of ODS should first undergo appropriate
bowel retraining.
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References
- Treatment strategies in obstructed defecation and fecal incontinence.World J Gastroenterol. 2006; 12: 3168-3173
- Epidemiology of constipation in North America: a systematic review.Am J Gastroenterol. 2004; 99: 750-759
- Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation.Dis Colon Rectum. 2008; 51 (discussion 195): 186-195
- Complex pelvic floor failure and associated problems.Best Pract Res Clin Gastroenterol. 2009; 23: 555-573
- Defecography in normal volunteers: results and implications.Gut. 1989; 30: 1737-1749
- Rectal intussusception in symptomatic patients is different from that in asymptomatic volunteers.Br J Surg. 2005; 92: 866-872
- Management of complex pelvic floor disorders in a multidisciplinary pelvic floor clinic.Colorectal Dis. 2008; 10: 118-123
- Obstructed defaecation: what is the role of rehabilitation?.Colorectal Dis. 2012; 14: 474-479
- Medical and surgical management of pelvic floor disorders affecting defecation.Am J Gastroenterol. 2012; 107: 1624-1633
- Prognostic significance of rectocele, intussusception, and abnormal perineal descent in biofeedback treatment for constipated patients with paradoxical puborectalis contraction.Dis Colon Rectum. 2000; 43: 478-482
- How could management of rectoceles be optimized?.ANZ J Surg. 2002; 72: 896-901
- Anterolateral rectopexy for correction of rectoceles leads to good anatomical but poor functional results.Tech Coloproctol. 2005; 9 (discussion 41): 35-41
- Rome III: the functional gastrointestinal disorders.3 ed. Degnon Associates, McLean (VA)2006
- Surgical repair of vaginal defects.Lippincott, Philadelphia (PA)1992
- Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome.Colorectal Dis. 2008; 10: 84-88
- Are rectoceles the cause or the result of obstructed defecation syndrome (ODS)? A prospective anorectal physiology study.Colorectal Dis. 2013; 15: 993-999
- Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome.Br J Surg. 2008; 95: 1521-1527
- Reinterventions after complicated or failed STARR procedure.Int J Colorectal Dis. 2009; 24: 87-95
- Stapled transanal rectal resection for symptomatic intussusception: morphological and functional outcome.Surg Endosc. 2010; 24: 1969-1975
- Incidence and clinical significance of sigmoidoceles as determined by a new classification system.Dis Colon Rectum. 1994; 37: 1112-1117
- Evacuation proctography in normal volunteers.Invest Radiol. 1991; 26: 581-585
- Rectocele and intussusception: is there any coherence in symptoms or additional pelvic floor disorders?.Tech Coloproctol. 2009; 13 (discussion 25-6): 17-25
- Enterocele revealed by simultaneous evacuation proctography and peritoneography: does “defecation block” exist?.AJR Am J Roentgenol. 1996; 167: 461-466
- Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defaecation.Int J Colorectal Dis. 2005; 20: 83-85
- Functional results after laparoscopic rectopexy for rectal prolapsed.J Gastrointest Surg. 2000; 4: 632-641
- Transanal Delorme procedure for treatment of rectocele associated with rectal intussusception.Tech Coloproctol. 2006; 10: 389
- Sacral nerve stimulation for intractable constipation.Gut. 2010; 59: 333-340
- Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation.Gastroenterology. 2005; 129: 86-97
- Biofeedback therapy for rectal intussusceptions.Tech Coloproctol. 2006; 10 (discussion 15-6): 11-15
- Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial.Dis Colon Rectum. 2008; 51: 1611-1618
- Treatment of impaired defecation associated with rectocele by behavorial retraining (biofeedback).Dis Colon Rectum. 2000; 43: 1267-1272
- Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation.Tech Coloproctol. 2003; 7: 148-153
- Stapled transanal rectal resection for obstructed defaecation and evidence-based practice.Br J Surg. 2005; 92: 793-794
- The dark side of double-stapled transanal rectal resection.Dis Colon Rectum. 2005; 48 (author reply 1831-2): 1830-1831
- Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation.Colorectal Dis. 2006; 8: 98-101
- Rectovaginal fistula after STARR procedure complicated by haematoma of the posterior vaginal wall: report of a case.Tech Coloproctol. 2006; 10: 361-363
- Proctalgia in a patient with staples retained in the puborectalis muscle after STARR operation.Tech Coloproctol. 2007; 11: 353-356
- Rectocele repair: a randomized trial of three surgical techniques including graft augmentation.Am J Obstet Gynecol. 2006; 195: 1762-1771
- Postdefaecation pain syndrome after circular stapled anopexy is abolished by oral nifedipine.Br J Surg. 2005; 92: 208-210
- Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results.Colorectal Dis. 2010; 12: 97-104
Article info
Publication history
Published online: December 06, 2013
Accepted:
November 26,
2013
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Biofeedback and electrostimulation: Last chance or first choice for obstructed defecation?SurgeryVol. 157Issue 2
- PreviewWe read with interest the article published by Hicks et al1 on the efficacy of biofeedback (BFB) treatment in more than 90 patients with symptoms of rectocele and obstructed defecation (ODS; 70% of patients experienced improvement in their symptoms after BFB). The authors underlined the efficacy of BFB therapy in patients with rectocele, expecially in those with rectocele plus internal rectal prolapse. According to several authors, operative repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after operative treatment.
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