title: Obstructed defaecation: what is the role of rehabilitation?
abstract: OBJECTIVE
  The study was designed to evaluate the results of rehabilitative treatment in patients suffering from obstructed defaecation.
  
  
  METHODS
  Between January 2008 and July 2010, 39 patients (37 women, age range 25-73 years; and two men, aged 57 and 67 years) affected by obstructed defaecation were included in the study. After a preliminary clinical evaluation, including the Obstructed Defaecation Syndrome (ODS) score, defaecography and anorectal manometry were performed. All 39 patients underwent rehabilitative treatment according to the 'multimodal rehabilitative programme' for obstructive defaecation. At the end of the programme, all 39 patients were reassessed by clinical evaluation and anorectal manometry. Postrehabilition ODS scores were used to categorize patients arbitrarily into three classes, as follows: class I, good (score ≤ 4); class II, fair (score > 4 to ≤ 8); and class III, poor (score > 8).
  
  
  RESULTS
  After rehabilitation, there was significant improvement in the overall mean ODS score (P < 0.001). Thirty (76.9%) patients were included as class I (good results), of whom eight (20.5%) were symptom free. Five (12.8%) patients were considered class III. A significant postrehabilitative direct correlation was found between ODS score and pelvic surgery (ρ(s) = 0.54; P < 0.05). Significant differences were found between pre- and postrehabilitative manometric data from the straining test (P < 0.001), duration of maximal voluntary contraction (P < 0.001) and conscious rectal sensitivity threshold (P < 0.02).
  
  
  CONCLUSIONS
  After rehabilitation, some patients become symptom free and many had an improved ODS score.
authors.affiliation: Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pucciani
authors.forename: M
authors.initials: M
authors.lastname: Reggioli
authors.forename: M N
authors.initials: MN
authors.lastname: Ringressi
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D001676:Biofeedback, Psychology; D003131:Combined Modality Therapy; D003248:Constipation / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy; D004733:Enema; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum / Q000503:physiopathology; D012720:Severity of Illness Index; D016896:Treatment Outcome