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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1053-1060
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1053
Management of obstructed defecation
Vlasta Podzemny, Lorenzo Carlo Pescatori, Mario Pescatori
Vlasta Podzemny, Lorenzo Carlo Pescatori, Mario Pescatori, Coloproctology Unit, Parioli Clinic, 00100 Rome, Italy
Author contributions: Pescatori LC and Podzemny V reviewed the literature; Pescatori M wrote the paper; Podzemny V revised the English language; Pescatori LC, Pescatori M and Podzemny V approved the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lorenzo Carlo Pescatori, MD, Coloproctology Unit, Parioli Clinic, Via Felice Giordano 8, 00100 Rome, Italy. lorenzo.carlo.pescatori@gmail.com
Telephone: +39-33-81388577 Fax: +39-6-80777290
Received: June 23, 2014
Peer-review started: June 23, 2014
First decision: July 21, 2014
Revised: August 3, 2014
Accepted: September 29, 2014
Article in press: September 30, 2014
Published online: January 28, 2015
Abstract

The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an “iceberg syndrome”, with “emerging rocks”, rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has “underwater rocks” or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone’s enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.

Keywords: Constipation, Obstructed defecation, Pelvic floor rehabilitation, Rectopexy, Rectal prolaxectomy

Core tip: Obstructed defecation mainly effect women and may be due both to functional and organic disorders. Some of them, i.e., rectocele, are more evident and easy to detect. Two out of ten patients present with occult causes, more difficult to diagnose, which may be looked at as “underwater rocks” of an iceberg. Most patients may be treated conservatively, with fiber diet, laxatives, rectal irrigation, pelvic floor rehabilitation and psychotherapy; and a minority requires surgery, including rectocele repair, prolapse excision, rectopexy and, more rarely, transanal rectal resection. Due to its complex etiology and psychological involvement, obstructed defecation needs a multidisciplinary approach.