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Functional disorders of defecation: evaluation and treatment
Bryan J Feyen1, Satish S C Rao
1Satish S.C. Rao, MD, PhD, FRCP The University of Iowa Hospital and Clinics, Internal Medicine, GI Division, 200 Hawkins Drive, 4612 JCP, Iowa City, IA 52242, USA. satish-rao@uiowa.edu.
Current Treatment Options in Gastroenterology
|June 6, 2007
Summary
Functional defecation disorders, often linked with slow-transit constipation, can be effectively managed. Biofeedback therapy shows promise for dyssynergic defecation, while surgical options are emerging for structural issues.
Area of Science:
- Gastroenterology and Colorectal Surgery
- Pelvic Floor Disorders
Background:
- Functional defecation disorders are prevalent and frequently co-occur with slow-transit constipation.
- These disorders encompass both functional obstructive conditions like dyssynergic defecation and structural issues such as rectal prolapse, excessive perineal descent, and rectocele.
Purpose of the Study:
- To review the evaluation and treatment of functional defecation disorders.
- To highlight recent advancements in therapeutic approaches.
Main Methods:
- Evaluation involves detailed patient history, physical examination (rectal and pelvic), and physiological tests.
- Physiological tests include anorectal manometry, balloon expulsion test, defecography, and MRI.
Main Results:
- Randomized controlled trials demonstrate biofeedback therapy's efficacy for dyssynergic defecation.
- Stapled transanal rectal resection shows potential for treating defecation disorders linked to rectocele, excessive perineal descent, and mucosal intussusception, though further controlled trials are needed.
Conclusions:
- A multi-faceted approach involving medical, behavioral, and surgical treatments is essential for managing defecation disorders.
- Biofeedback therapy is a validated treatment for dyssynergic defecation, and surgical techniques like stapled transanal rectal resection warrant further investigation.
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