TY - JOUR
T1 - Treating pelvic floor disorders of defecation
T2 - Management or cure?
AU - Rao, Satish S.C.
AU - Go, Jorge T.
N1 - Funding Information:
The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Dr. Satish Rao is supported by National Institutes of Health grant RO1 DK 57100-05.
PY - 2009
Y1 - 2009
N2 - Pelvic floor disorders that affect defecation consist of structural disorders (eg, rectocele) and functional disorders (eg, dyssynergic defecation). Evaluation includes a thorough history and physical examination, a careful digital rectal examination, and physiologic tests such as anorectal manometry, colonic transit study, and balloon expulsion test. Defecography and dynamic MRI may facilitate detection of structural defects. Management consists of education and counseling regarding bowel function, diet, laxatives, and behavioral therapies. Recently, several randomized, clinical trials have shown that biofeedback therapy is effective in dyssynergic defecation. Dyssynergia may also coexist in structural disorders such as solitary rectal ulcer syndrome or rectocele. Hence, before proceeding with surgery, neuromuscular training or biofeedback should be considered. Several surgical approaches, including stapled transanal rectal resection, have been advocated, but well-controlled randomized studies are lacking and their efficacy is unproven.
AB - Pelvic floor disorders that affect defecation consist of structural disorders (eg, rectocele) and functional disorders (eg, dyssynergic defecation). Evaluation includes a thorough history and physical examination, a careful digital rectal examination, and physiologic tests such as anorectal manometry, colonic transit study, and balloon expulsion test. Defecography and dynamic MRI may facilitate detection of structural defects. Management consists of education and counseling regarding bowel function, diet, laxatives, and behavioral therapies. Recently, several randomized, clinical trials have shown that biofeedback therapy is effective in dyssynergic defecation. Dyssynergia may also coexist in structural disorders such as solitary rectal ulcer syndrome or rectocele. Hence, before proceeding with surgery, neuromuscular training or biofeedback should be considered. Several surgical approaches, including stapled transanal rectal resection, have been advocated, but well-controlled randomized studies are lacking and their efficacy is unproven.
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U2 - 10.1007/s11894-009-0041-3
DO - 10.1007/s11894-009-0041-3
M3 - Review article
C2 - 19615303
AN - SCOPUS:67849122714
SN - 1522-8037
VL - 11
SP - 278
EP - 287
JO - Current Gastroenterology Reports
JF - Current Gastroenterology Reports
IS - 4
ER -