Pelvic floor rehabilitation for defecation disorders

Abstract

Pelvic floor rehabilitation is frequently recommended for defecation disorders, in both constipation and fecal incontinence. However, the lack of patient selection, together with the variety of rehabilitation methods and protocols, often jeopardize the results of this approach, causing difficulty in evaluating outcomes and addressing proper management, and above all, in obtaining scientific evidence for the efficacy of these methods for specific indications. The authors represent different gastroenterological and surgical scientific societies in Italy, and their aim was to identify the indications and agree on treatment protocols for pelvic floor rehabilitation of patients with defecation disorders. This was achieved by means of a modified Delphi method, utilizing a working team (10 members) which developed the statements and a consensus group (15 members, different from the previous ones) which voted twice also suggesting modifications of the statements.

Staying in HRAM’s Way: Tweaking the London Classification for Disorders of Anorectal Function

“…The authors thoughtfully acknowledged the limitations of the study, namely its retrospective nature, the limited sample size, the single institution referral, and the primary focus on female patients with fecal incontinence, which skewed the tested population away from the full spectrum of anorectal disorders, including increased anal tone and contractility disorders [7]. Nevertheless, the study is carefully performed and reported, providing the first step in an evidence-based approach to modify the IAPWG protocol.…”

Enhanced recovery after surgery nursing program, a protective factor for stoma-related complications in patients with low rectal cancer

“…But several others factors that could alter physiologic defecation are implied in fecal continence. Bocchini et al [29] suggest the criteria for patients selection, evaluation of clinical presentation of defecatory disorders, appropriate education about concepts of pelvic anatomy and defecation physiology, and protocols of pelvic floor rehabilitation for defecation disorders, including fecal incontinence. Based on their reports, Brusciano et al [30] propose a modified physiatric assessment (combination of chest, abdomen, vertebral column, and perineum) instead of solely on the function and integrity of the pelvic floor.…”

Outlet Obstructed Constipation and Fecal Incontinence: Is Rehabilitation Treatment the Way? Myth or Reality

“…Such anatomical alterations can only be treated by a surgical approach. Pelviperineal rehabilitation is nowadays recognized as a proper treatment approach for constipation, associated with dietary and behavioral modifications when failure of conventional therapies may occur, when the diagnosis of anorectal functional constipation is correct, and the coordination disturbance is studied and clinically severe (8) . Fecal incontinence (patient's impossibility to hold feces or gas), is as well largely associated to functional alterations such as sphincteral muscular deficit, sensory deficit or muscular innervation deficit, all of these features can be amended by adequate pelvic floor rehabilitation.…”

“…Fecal incontinence (patient's impossibility to hold feces or gas), is as well largely associated to functional alterations such as sphincteral muscular deficit, sensory deficit or muscular innervation deficit, all of these features can be amended by adequate pelvic floor rehabilitation. Pelvic floor rehabilitation has a sort of established indication in fecal incontinence, according to literature in fact, pelvic floor rehabilitation may only be certainly useful for active incontinence even though, in passive incontinence, rehabilitation may be used to obtain striated muscle strengthening and a better awareness of the pelvic floor for better symptom management (8) . In our referral centre, we've had discrete results both in active, passive and mixed incontinence when due to functional matters.…”