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

Autor:	Mundet L; Gastrointestinal Motility Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Spain. Electronic address: lluismundetp@gmail.com., Raventós A; Gastrointestinal Motility Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain., Carrión S; Gastrointestinal Motility Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain., Bascompte C; Gastrointestinal Motility Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain., Clavé P; Gastrointestinal Motility Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.
Jazyk:	English; Spanish; Castilian
Zdroj:	Gastroenterologia y hepatologia [Gastroenterol Hepatol] 2024 Jun 08, pp. 502219. Date of Electronic Publication: 2024 Jun 08.
DOI:	10.1016/j.gastrohep.2024.502219
Abstrakt:	Background/aims: Defecation disorders can occur as a consequence of functional or structural anorectal dysfunctions during voiding. The aims of this study is to assess the prevalence of structural (SDD) vs functional (FDD) defecation disorders among patients with clinical complaints of obstructive defecation (OD) and their relationship with patients' expulsive capacity. Patients and Methods: Retrospective study of 588 patients with OD studied between 2012 and 2020 with evacuation defecography (ED), and anorectal manometry (ARM) in a subgroup of 294. Results: 90.3% patients were women, age was 58.5±12.4 years. Most (83.7%) had SDD (43.7% rectocele, 45.3% prolapse, 19.3% enterocele, and 8.5% megarectum), all SDD being more prevalent in women except for megarectum. Functional assessments showed: (a) absence of rectification of anorectal angle in 51% of patients and poor pelvic descent in 31.6% at ED and (b) dyssynergic defecation in 89.9%, hypertonic IAS in 44%, and 33.3% rectal hyposensitivity, at ARM. Overall, 46.4% of patients were categorized as pure SDD, 37.3% a combination of SDD+FDD, and 16.3% as having pure FDD. Rectal emptying was impaired in 66.2% of SDD, 71.3% of FDD and in 78% of patients with both (p=0.017). Conclusions: There was a high prevalence of SDD in middle-aged women with complaints of OD. Incomplete rectal emptying was more prevalent in FDD than in SDD although FDD and SDD frequently coexist. We recommend a stepwise therapeutic approach always starting with therapy directed to improve FDD and relaxation of striated pelvic floor muscles. (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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