Medical and surgical management of pelvic floor disorders affecting defecation.
Pelvic floor disorders that affect stool evacuation include structural (for example, rectocele) and functional disorders (for example, dyssynergic defecation (DD)). Meticulous history, digital rectal examination (DRE), 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 (MRI) can facilitate an objective diagnosis and optimal treatment. 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 DD. Because DD may coexist with conditions such as solitary rectal ulcer syndrome (SRUS) and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. 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.
Section of Neurogastroenterology, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242-1081, USA. Ron-schey@uiowa.edu
Ron
R
Schey
John
J
Cromwell
Satish S C
SS
Rao
D003672:Defecation; D003952:Diagnostic Imaging; D013505:Digestive System Surgical Procedures / Q000379:methods; 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*