Does the presence of a high grade internal rectal prolapse affect the outcome of pelvic floor retraining in patients with faecal incontinence or obstructed defaecation?
| Autor: | Ian Lindsey, S. Adusumilli, K. Curran, Martijn P. Gosselink, O. M. Jones, Simona Fourie, Chris Cunningham |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Constipation Manometry medicine.medical_treatment education Urology Anal Canal Biofeedback Severity of Illness Index Quality of life Surveys and Questionnaires medicine Humans In patient Defecation Aged Defecography Pelvic floor business.industry Anorectal manometry Gastroenterology Pelvic Floor Rectal Prolapse Middle Aged medicine.disease Exercise Therapy Surgery Rectal prolapse Treatment Outcome medicine.anatomical_structure Quality of Life Female Biofeedback therapy medicine.symptom business Fecal Incontinence |
| Zdroj: | Colorectal Disease. 15:e680-e685 |
| ISSN: | 1462-8910 |
| Popis: | Aim Pelvic floor retraining is considered first-line treat-ment for patients with faecal incontinence or obstructeddefaecation. There are at present no data on the effectof a high grade internal rectal prolapse on outcomes ofpelvic floor retraining. The current study aimed toassess this influence.Method In all, 120 consecutive patients were offeredpelvic floor retraining. The predominant symptom wasfaecal incontinence in 56 patients (47%) and obstructeddefaecation in 64 patients (53%). Patients were assessedbefore and after therapy using the Fecal IncontinenceSeverity Index (FISI), the Patient Assessment of Consti-pation Symptoms (PAC-SYM) score and the Gastroin-testinal Quality of Life Index (GIQLI). Defaecographyand anorectal manometry were performed in all patientsbefore pelvic floor retraining.Results A high grade internal rectal prolapse wasobserved in 42 patients (35%). In patients with faecalincontinence without a high grade internal rectal pro-lapse, the FISI score decreased from 36 to 27(P < 0.01). The FISI score did not change (32 vs 32;P = 0.93) in patients with a high grade internal rectalprolapse. The PAC-SYM score improved significantly(24 vs 19; P = 0.01) in patients with obstructed defae-cation without a high grade rectal prolapse comparedwith no significant change (26 vs 25; P = 0.21) inpatients with a high grade rectal prolapse. Quality of life(GIQLI) improved only in patients without a highgrade internal rectal prolapse.Conclusion Pelvic floor retraining may be useful inpatients with defaecation disorders not associated with ahigh grade internal rectal prolapse. Patients with a highgrade internal rectal prolapse may be considered for sur-gery from the outset.Keywords Constipation, obstructed defaecation, faecalincontinence, internal rectal prolapse, biofeedbackWhat does this paper add to the literature?This is the first paper to address how the presence of ahigh grade internal prolapse affects the outcome of pelvicfloor retraining. It also provides some guidance on whichpatients may benefit from biofeedback therapy. |
| Databáze: | OpenAIRE |
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