Obstructed Defecation Syndrome After Delivery Trauma

Area of Science:

• Colorectal surgery
• Gynecology
• Pelvic floor disorders

Background:

• Obstructed defecation syndrome (ODS) affects approximately 7% of adults, with multifactorial etiology.
• Pregnancy and childbirth are implicated in pelvic floor disorders, potentially damaging pelvic nerves and muscles.
• The specific impact of vaginal delivery (VD) on ODS is not fully understood, though operative VD and episiotomy have been linked to pelvic floor issues.

Purpose of the Study:

• To evaluate the outcomes of stapled transanal rectal resection (STARR) in women with ODS.
• To compare STARR outcomes between women who delivered vaginally (VD) and those who had a Cesarean section (C/S).
• To assess the influence of episiotomy during VD on ODS severity and treatment outcomes.

Main Methods:

• A prospective study involving 30 women with ODS undergoing STARR.
• Longo's ODS score was used to measure pelvic floor malfunction severity.
• Women were categorized into VD, C/S, and VD with episiotomy subgroups for comparative analysis.

Main Results:

• Of 30 women, 19 (63.3%) had VD and 11 (36.7%) had C/S.
• Women with C/S presented with higher pre-operative ODS scores compared to those with VD.
• No significant difference was observed in the post-STARR ODS score improvement between VD and C/S groups.

Conclusions:

• Cesarean section (C/S) does not prevent pelvic organ trauma from pregnancy and delivery.
• Episiotomy during vaginal delivery (VD) may mitigate pelvic organ trauma severity.
• STARR is an effective treatment for ODS, regardless of delivery mode, but C/S does not offer protection against ODS development.