Medical and surgical management of pelvic floor disorders affecting defecation

Ron Schey, John Cromwell, Satish Sanku Chander Rao

Research output: Contribution to journalReview article

34 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1624-1633
Number of pages10
JournalAmerican Journal of Gastroenterology
Volume107
Issue number11
DOIs
StatePublished - Nov 1 2012

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Pelvic Floor Disorders
Defecation
Rectocele
Defecography
Therapeutics
Digital Rectal Examination
Laxatives
Manometry
Robotics
Pelvis
Ulcer
Counseling
Colon
Randomized Controlled Trials
History
Magnetic Resonance Imaging
Diet
Education
Biofeedback (Psychology)

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Medical and surgical management of pelvic floor disorders affecting defecation. / Schey, Ron; Cromwell, John; Rao, Satish Sanku Chander.

In: American Journal of Gastroenterology, Vol. 107, No. 11, 01.11.2012, p. 1624-1633.

Research output: Contribution to journalReview article

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