The patient with obstructed defecatory symptoms: Management differs considerably between physicians and surgeons

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Obstructed defecatory symptoms (ODS) often lead to referrals to gastroenterologists (GE) or colorectal surgeons (CS).
• Referral choice can influence patient management strategies for ODS.

Purpose of the Study:

• To investigate and compare the diagnostic and management approaches of GE and CS for patients with ODS.
• To identify practice variations and their impact on ODS patient treatment pathways.

Main Methods:

• An online survey was distributed to GE and CS in Australia and New Zealand.
• Respondents were presented with a case vignette of ODS and various management scenarios.

Main Results:

• GE favored anorectal manometry, while CS preferred dynamic imaging for ODS patients. A significant portion of both specialists referred patients directly to physiotherapy.
• Knowledge of dynamic imaging results, particularly rectocele presence, influenced management decisions, shifting GE towards CS consultation and CS towards surgical options.
• Most GE and CS did not deem gynecological consultation necessary, even with a rectocele.

Conclusions:

• Practice variations among medical specialties impact diagnostic and management recommendations for ODS.
• The study underscores the need for interdisciplinary, standardized management guidelines for obstructed defecatory symptoms.