title: Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome.
abstract: BACKGROUND
  Management of patients with obstructed defecation syndrome is still controversial.
  
  
  OBJECTIVE
  To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography.
  
  
  METHODS
  The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure.
  
  
  RESULTS
  Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit.
  
  
  CONCLUSIONS
  Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts.
authors: Department of Anorectal Physiology, School of Medicine, Federal University of Ceará, CE, Brazil. smregadas@hospitalsaocarlos.com.br
authors: Sthela Maria
authors: SM
authors: Murad-Regadas
authors: Francisco Sergio P
authors: FS
authors: Regadas
authors: Lusmar Veras
authors: LV
authors: Rodrigues
authors: Graziela Olivia da Silva
authors: GO
authors: Fernandes
authors: Guilherme
authors: G
authors: Buchen
authors: Viviane T
authors: VT
authors: Kenmoti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D007443:Intussusception / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology*; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D020047:Rectocele / Q000000981:diagnostic imaging / Q000628:therapy*; D012720:Severity of Illness Index; D013577:Syndrome; D016896:Treatment Outcome; D014463:Ultrasonography