Pelvic floor training improves faecal incontinence and obstructed defaecation despite the presence of rectal intussusception

Abstract

Background Rectal intussusception is often observed in patients with faecal incontinence and obstructed defaecation. The aim of this study is to assess if pelvic floor training improves faecal incontinence and obstructed defaecation in patients with rectal intussusception. Methods Case notes of all patients referred to Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018 for the management of faecal incontinence and obstructed defaecation and rectal intussusception were retrospectively reviewed using a prospectively maintained database. St Mark's faecal incontinence and Cleveland clinic constipation scores were obtained from patients before and after they underwent pelvic floor training. Results One hundred and thirty‐one patients underwent pelvic floor training at Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018. Sixty‐one patients had rectal intussusception (22 low‐grade and 39 high‐grade). Median St Marks score improved following pelvic floor training from 8 to 1 (P < 0.001). Median Cleveland Clinic constipation score improved from 8 to 5 (P < 0.001). In patients with low grade rectal intussusception, pelvic floor training improved median St Mark's score from 3 to 0 (P = 0.003), whereas Cleveland Clinic constipation score improved from 9 to 7 (P < 0.001). In patients with high‐grade rectal intussusception, pelvic floor training improved median St Mark's score from 9 to 2 (P < 0.001), whereas median Cleveland Clinic constipation score improved from 8 to 4 (P < 0.001). Conclusion Pelvic floor training without biofeedback therapy improves faecal incontinence and obstructed defaecation. Improvement in symptoms is unrelated to rectal intussusception observed on proctography or at examination under anaesthesia in these patients.

Pelvic floor retraining in patients with high‐grade internal rectal prolapse

“…We read with interest the article by Albayati et al who analysed outcomes of pelvic floor retraining in patients with faecal incontinence (by St Mark's score) and/or obstructed defaecation (by Cleveland score), with the added presence of internal rectal prolapse documented on proctography. 1 Since this is only the second paper to have diligently documented the structural influence on outcomes of conservative management, they are to be commended.…”