Management of obstructed defecation

Podzemny, Vlasta; Pescatori, Lorenzo; Pescatori, Mario

doi:10.3748/wjg.v21.i4.1053

Cited by 89 publications

(73 citation statements)

References 91 publications

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“…29,82 Injection of botulinum toxin into the anal sphincter has been tried with mixed results. 29,83 In both of these studies there was some improvement in less than one half of patients but troublesome incontinence occurred in one study.…”

Section: Other Measures For Dyssynergic Defecation Treatmentmentioning

confidence: 99%

Diagnosis and Treatment of Dyssynergic Defecation

Rao

Patcharatrakul

2016

J Neurogastroenterol Motil

195

149

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Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights. Recently, randomized controlled trials have shown that biofeedback therapy is more effective than laxatives and other modalities, both in the short term and long term, without side effects. Also, symptom improvements correlated with changes in underlying pathophysiology. Biofeedback therapy has been recommended as the first-line of treatment for dyssynergic defecation. Here, we provide an overview of the burden of illness and pathophysiology of dyssynergic defecation, and how to diagnose and treat this condition with biofeedback therapy.

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Section: Other Measures For Dyssynergic Defecation Treatmentmentioning

confidence: 99%

Diagnosis and Treatment of Dyssynergic Defecation

Rao

Patcharatrakul

2016

J Neurogastroenterol Motil

195

149

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“…Therefore, they must be used with caution in patients with a history of electrolyte imbalance including severe renal impairment, in the elderly, in patients with uncontrolled high blood pressure, and in patients with heart failure. Enema abuse may also result in anorectal fibrosis and stenosis from repeat microtrauma (147).…”

Section: Side Effectsmentioning

confidence: 99%

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult

Mearin¹,

Ciriza²,

Mínguez³

et al. 2016

Rev Esp Enferm Dig

103

151

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In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.

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“…The best approach will first address systemic causes, then address stool frequency and toileting behaviors. Stool bulking and biofeedback have been shown to improve defecatory dysfunction resulting from multiple causes, and because of their minimal risks of adverse effects, they are considered safe and reasonable first line treatments[8]. …”

Section: Introductionmentioning

confidence: 99%

Current Trends in Management of Defecatory Dysfunction, Posterior Compartment Prolapse, and Fecal Incontinence

Brown

Grimes

2016

Curr Obstet Gynecol Rep

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While it would be our hope to report that there have been significant gains in the understanding of the correlation between the posterior vaginal compartment and defecatory dysfunction in the last year, this is not the case. Instead, we review the highlights of management of posterior vaginal compartment and defecatory dysfunction including 1) defining and understanding the patient's symptoms; 2) considering systemic disorders, motility dysfunction, and mechanical causes that may be contributing; 3) encouraging conservative management as first-line therapy; and 4) recognizing which surgical options are likely to improve specific symptoms. This is then followed by an update on treatment options for fecal incontinence, which we now prefer to refer to as accidental bowel leakage. We are able to report on five exciting and innovative treatment approaches for accidental bowel leakage. As the scientific community increases focus on patient-centered outcomes, we are likely on the verge of having a greater understanding of how treatment options for posterior compartment prolapse and defecatory dysfunction can improve patient symptoms. This year, we can report that strong evidence based recommendations simply do not exist, and this area is ripe for future investigation.

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Management of obstructed defecation

Cited by 89 publications

References 91 publications

Diagnosis and Treatment of Dyssynergic Defecation

Diagnosis and Treatment of Dyssynergic Defecation

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult

Current Trends in Management of Defecatory Dysfunction, Posterior Compartment Prolapse, and Fecal Incontinence

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