Treating pelvic floor disorders of defecation: management or cure?
Pelvic floor disorders that affect defecation consist of structural disorders (eg, rectocele) and functional disorders (eg, dyssynergic defecation). Evaluation includes a thorough history and physical examination, a careful digital rectal examination, and physiologic tests such as anorectal manometry, colonic transit study, and balloon expulsion test. Defecography and dynamic MRI may facilitate detection of structural defects. Management consists of education and counseling regarding bowel function, diet, laxatives, and behavioral therapies. Recently, several randomized, clinical trials have shown that biofeedback therapy is effective in dyssynergic defecation. Dyssynergia may also coexist in structural disorders such as solitary rectal ulcer syndrome or rectocele. Hence, before proceeding with surgery, neuromuscular training or biofeedback should be considered. Several surgical approaches, including stapled transanal rectal resection, have been advocated, but well-controlled randomized studies are lacking and their efficacy is unproven.
Rao
Satish S C
SS
The University of Iowa Hospitals and Clinics, Internal Medicine, GI Division, 200 Hawkins Drive, 4612 JCP, Iowa City, IA 52242, USA. satish-rao@uiowa.edu
Go
Jorge T
JT
D003672:Defecation; D003952:Diagnostic Imaging; D005772:Gastrointestinal Transit; D006801:Humans; D008365:Manometry; D008487:Medical History Taking; D017773:Pelvic Floor / Q000503:physiopathology*; D010808:Physical Examination; D016032:Randomized Controlled Trials as Topic; D012002:Rectal Diseases / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy*