Characterization of obstructive defecation from a structural and a functional perspective.

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Defecation disorders stem from anorectal dysfunctions.
• Obstructive defecation (OD) presents with clinical complaints.
• Understanding structural (SDD) vs. functional (FDD) defecation disorders is crucial.

Purpose of the Study:

• Assess the prevalence of SDD versus FDD in OD patients.
• Examine the relationship between defecation disorders and expulsive capacity.
• Identify demographic and clinical characteristics of patients with OD.

Main Methods:

• Retrospective study of 588 OD patients (2012-2020).
• Utilized evacuation defecography (ED) for all patients.
• Employed anorectal manometry (ARM) in a subgroup of 294 patients.

Main Results:

• High prevalence of SDD (83.7%) noted, particularly in women.
• Functional deficits included absent anorectal angle rectification (51%) and dyssynergic defecation (89.9%).
• Impaired rectal emptying occurred in 66.2% of SDD, 71.3% of FDD, and 78% of combined cases.

Conclusions:

• SDD is highly prevalent in middle-aged women with OD.
• FDD and SDD frequently coexist and both impair rectal emptying.
• A stepwise approach, prioritizing FDD therapy, is recommended.