Author(s): MuradRegadas SM, Regadas FS, Rodrigues LV, Fernandes GO, Buchen G,
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Abstract CONTEXT: 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.
This article was published in Arq Gastroenterol
and referenced in Internal Medicine: Open Access