Medical and surgical management of pelvic floor disorders affecting defecation

Ron Schey; John Cromwell; Satish S C Rao

doi:10.1038/ajg.2012.247

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Medical and surgical management of pelvic floor disorders affecting defecation

Journal article

Peer reviewed

Medical and surgical management of pelvic floor disorders affecting defecation

Ron Schey, John Cromwell and Satish S C Rao

The American journal of gastroenterology, Vol.107(11), pp.1624-1633

11/2012

DOI: 10.1038/ajg.2012.247

PMCID: PMC4000585

PMID: 22907620

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Abstract

Pelvic floor disorders that affect stool evacuation include structural (for example, rectocele) and functional disorders (for example, dyssynergic defecation (DD)). Meticulous history, digital rectal examination (DRE), and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion, and imaging studies such as anal ultrasound, defecography, and static and dynamic magnetic resonance imaging (MRI) can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and finally surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating DD. Because DD may coexist with conditions such as solitary rectal ulcer syndrome (SRUS) and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic, and transabdominal approach, stapled transanal rectal resection, and robotic colon and rectal resections. However, there is lack of well-controlled randomized studies and the efficacy of these surgical procedures remains to be established.

Manometry

Medical History Taking

Humans

Rectal Diseases - physiopathology

Randomized Controlled Trials as Topic

Diagnostic Imaging

Gastrointestinal Transit

Rectal Diseases - therapy

Pelvic Floor - physiopathology

Physical Examination

Defecation

Digestive System Surgical Procedures - methods

Rectal Diseases - diagnosis

Details

Title: Subtitle: Medical and surgical management of pelvic floor disorders affecting defecation
Creators: Ron Schey - Section of Neurogastroenterology, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242-1081, USA. Ron-schey@uiowa.edu
John Cromwell
Satish S C Rao
Resource Type: Journal article
Publication Details: The American journal of gastroenterology, Vol.107(11), pp.1624-1633
DOI: 10.1038/ajg.2012.247
PMID: 22907620
PMCID: PMC4000585
NLM abbreviation: Am J Gastroenterol
ISSN: 0002-9270
eISSN: 1572-0241
Publisher: United States
Grant note: R01 DK057100 / NIDDK NIH HHS R01 DK 57100-05 / NIDDK NIH HHS
Language: English
Date published: 11/2012
Academic Unit: Surgery
Record Identifier: 9984051992402771

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