Skip to main content
SpringerLink
Log in
Book cover

Coloproctology pp 139–148Cite as

The Surgical Management of Evacutory Dysfunction

  • Chapter
  • First Online:

  • 905 Accesses

Part of the book series: Springer Specialist Surgery Series ((SPECIALIST))

Abstract

Evacuatory Dysfunction refers to a constellation of symptoms such as prolonged repeated straining at bowel movements, sensation of incomplete evacuation, and the need for digital manipulation. Evacuatory dysfunction is used interchangeably with obstructed defecation syndrome (ODS), outlet constipation, and pelvic outlet obstruction and is a common complaint of women. In a cohort of 2,000 women ages 40-69 years 60% of respondents self-reported symptoms of ODS over a 12-month period while 12% reported symptoms of ODS weekly (Varma et al. 2008).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Agachan F, Chen T, Pfeifer J, Reisman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996;39:681-685

    Article  PubMed  CAS  Google Scholar 

  • Arroyo A, González-Argenté FX, García-Domingo M, Espin-Basany E, De-la-Portilla F, Pérez-Vicente F, Calpena R (2008) Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg 95(12):1521-1527

    Article  PubMed  CAS  Google Scholar 

  • Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47(8):1285-1296

    Article  PubMed  Google Scholar 

  • Brown AJ, Anderson H, McKee RF, Finlay JG (2004) Surgery for occult rectal prolapse. Colorectal Dis 6:176-179

    Article  PubMed  CAS  Google Scholar 

  • Bump RC Mattiasson A Bo K Brubaker LP DeLancey JO Klarskov P Shull BL Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1): 10-7

    Article  PubMed  CAS  Google Scholar 

  • D’ Hoore A, Penninckx F (2003) Obstructed defecation. Colorectal Dis 5:280-287

    Article  Google Scholar 

  • Dippolito A, Esser S, Reed J 3rd (2005) Anterior modification of Delorme procedure provides equivalent results to Delorme procedure in treatment of rectal outlet obstruction. Curr Surg 62(6):609-612

    Article  PubMed  Google Scholar 

  • Drossman D, Corazziari E, Talley NJ, Thompson WG, Whitehead WE (eds) (2000) Rome III the functional gastrointestinal disorders diagnosis, pathophysiology and treatment. A multinational consensus, 2nd edn. Degnon Associates, Mclean Va

    Google Scholar 

  • Fenner DE (1996) Diagnosis and assessment of sigmoidoceles. Am J Obset Gynecol 175(6):1438-1442

    Article  CAS  Google Scholar 

  • Frascio Frascio M, Stabilini C, Ricci B, Marino P, Fornaro R, De Salvo L, Mandolfino F, Lazzara F, Gianetta E (2008) Stapled transanal rectal resection for outlet obstruction syndrome: results and follow up. World J Surg 32(6): 1110-1115

    Article  Google Scholar 

  • Ganio E, Masin A, Ratto C, Altomare DF et al (2001) Short- term sacral nerve stimulation for functional anorectal and urinary disturbances: results in 40 patients: evaluation of a new option for anorectal functional disorders. Dis Colon Rectum 44(9):1261-1267

    Article  PubMed  CAS  Google Scholar 

  • Gerharz EW, Vik W, Webb G, Leaver R, Shah PJ, Woodhouse CR (1997) The value of the MACE procedure in adult patients. J AM Coll. Surg 185:544-547

    Article  PubMed  CAS  Google Scholar 

  • Gladman MA, Scott SM, Lunniss PJ, Williams NS (2005) Systemic review of surgical options for idiopathic megarectum and megacolon. Ann Surg 241(4):562-574

    Article  PubMed  Google Scholar 

  • Gladman MA, Williams NS, Scott SM, Ogunbiyi OA, Lunniss PJ (2005) Medium- term results of vertical reduction rectoplasty and sigmoid colectomy for idiopathic megarectum. Br J Surg 92(5):624-630

    Article  PubMed  CAS  Google Scholar 

  • Gladman MA, Dvorkin LS, Scott SM, Lunniss PJ, Williams NS (2007) A novel technique to identify patients with megarectum. Dis Colon Rectum 50(5):621-629

    Article  PubMed  Google Scholar 

  • Graf W, Karlbom U, Pahlman U, Nilsson S, Ejerblad S (1996) Functional results after abdominal suture rectopexy for rectal prolapse or intussusception. Eur J Surg 162(11): 905-911

    PubMed  CAS  Google Scholar 

  • Gustilo-Ashby AM, Paraiso MFR, Jelovsek JE, Walters MD, Barber MD (2007) Bowel symptoms one year after surgery for prolapse: further analysis of a randomized trial of rectocele repair. Am J Obstet Gynecol 197(1):76-78

    Article  PubMed  Google Scholar 

  • Heyman S, Scarlett Y, Jones K et al (2007) Randomized controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia constipation. Dis Colon Rectum 50(4): 428-417

    Article  Google Scholar 

  • Hirst GR, Arumugam PJ, Watkins AJ, Mackey P, Morgan AR, Carr ND, Beynon (2005) Antegrade continence enema in the treatment in the treatment of obstructed defecation with or without fecal incontinence. Tech Coloproctol 9:217-221

    Article  PubMed  CAS  Google Scholar 

  • Holzer B, Rosen HR, Novi G et al (2008) Sacral nerve stimulation in patients with severe constipation. Dis Colon Rectum 51:524-530

    Article  PubMed  CAS  Google Scholar 

  • Hosie KB, Kmiot WA, Keighley MR (1990) Constipation: another indication for restorative proctocolectomy. Br J Surg 77:801-802

    Article  PubMed  CAS  Google Scholar 

  • Johnson E, Carlsen E, Mjåland O, Drolsum A (2003) Resection rectopexy for internal rectal intussusception reduces constipation and incomplete evacuation of stool. Eur J Surg 588(Suppl):51-56

    Google Scholar 

  • Jorge JM, Wang YK, Wexner SD (1994) Incidence and clinical significance of sigmoidoceles as determined by a new classification system. Dis Colon Rectum 37: 1112-1117

    Article  PubMed  CAS  Google Scholar 

  • Kahn M, Stanton S, Kumar D, Fox SD (1999) Posterior ­colporrhaphy is superior to the transanal repair for treatment of posterior vaginal wall prolapse. Neurourol Urodyn 18:70-71

    Google Scholar 

  • Kariv Y, Delaney CP, Casillas S, Hammel J, Nocero J, Bast J, Brady K, Fazio VW, Senagore AJ (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse. Surg Endosc 20:35-34

    Article  PubMed  CAS  Google Scholar 

  • Kenefick NJ (2006) Sacral neuromodulation for the treatment of lower bowel motility disorders. Ann R Coll Surg Engl 88(7):617-623

    Article  PubMed  Google Scholar 

  • Kenefick NJ, Nicholls RJ, Cohen RG, Kamm MA (2002) Permanent sacral nerve stimulation for treatment of idiopathic constipation. Br J Surg 89:882-888

    Article  PubMed  CAS  Google Scholar 

  • Kenefick NJ, Vaizey CJ, Cohen CR, Nicholls RJ, Kamm MA (2002) Double- blind placebo- controlled crossover study of sacral nerve stimulation for idiopathic constipation. Br J Surg 89:1570-1571

    Article  PubMed  CAS  Google Scholar 

  • Kiely EM, Ade-Ajayi N, Wheeler RA (1994) Caecal flap conduit for antegrade continence enemas. Br J Surg 81(8):1215

    Article  PubMed  CAS  Google Scholar 

  • Kuijupers HC (1992) Treatment of complete rectal prolapse: to narrow, to wrap, to suspend, to fix, to encircle, to plicate or resect ? World J Surg 16(5):826-830

    Article  Google Scholar 

  • Lees NP, Hodson P, Hill J, Pearson RC, MacLennan I (2004) Long- term results of the antegrade continent enema procedure for constipation in adults. Colorectal Dis 6: 362-368

    Article  PubMed  CAS  Google Scholar 

  • Lehur PA, Stuto A, Fantoli M, Villani RD, Queralto M, Lazorthes F, Hershman M, Carriero A, Pigot F, Meurette G, Narisetty P, Villet R (2008) ODS II Study Group. Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial. Dis Colon Rectum. 51(11):1611-1618

    Article  PubMed  Google Scholar 

  • Liberman H, Hughes C, Dippolito A (2000) Evaluation and outcome of the delorme procedure in the treatment of rectal outlet obstruction. Dis Colon Rectum 43(2): 188-192

    Article  PubMed  CAS  Google Scholar 

  • Liu YG, Zang JX, Li YW, Gao CF, Xu Z (2001) Treatment of musculi puborectalis syndrome with partial resection of musculi puborectalis: analysis in 149 cases. J LuoYang Med Coll 19:17-18

    Google Scholar 

  • Malone PS, Ransley PG, Kiely EM (1990) Preliminary report: the antegrade continence mechanism. Lancet 336: 1217-1218

    Article  PubMed  CAS  Google Scholar 

  • Malouf AJ, Wiesel PH, Nicholls T, Nicholls JR, Kamm MA (2002) Short term effects of sacral nerve stimulation for idiopathic slow transit constipation. Word J Surg 26:166-170

    Article  Google Scholar 

  • Maria G, Anastasio G, Brisinda G, Civello IM (1997) Treatment of puborectalis syndrome with progressive anal dilation. Dis Colon Rectum 40:89-92

    Article  PubMed  CAS  Google Scholar 

  • Maria G, Cadeddu F, Brandara F, Marniga G, Brisinda G (2006) Experience with type A botulinum toxin for treatment of outlet-type constipation. Am J Gastroenterol 101(11):2570-2575

    Article  PubMed  Google Scholar 

  • McKee RF, Lauder JC, Poon FW, Aitchison MA, Finlay IG (1992) A prospective randomized trial of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gyn Obstet 174:145-148

    CAS  Google Scholar 

  • Mellgren A, Bremmer S, Johansson C, Dolk A, Uden R, Ahlback SO, Holmstrom B (1994) Defecography results of investigations in 2,816 patients. Dis Colon Rectum 37:1133-1141

    Article  PubMed  CAS  Google Scholar 

  • Mellgren A, Schultz I, Johansson C, Dolk A (1997) Internal rectal intussusception seldom develops into total rectal prolapse. Dis Colon Rectum 40(7):817-820

    Article  PubMed  CAS  Google Scholar 

  • Mitrofanoff P (1980) Cystostomie continenente trans-­appendiculare dans le traitment des vessies neurologiques. Chir Pediatr 21:297-305

    PubMed  CAS  Google Scholar 

  • Monti PR, Lara RC, Dutra MA, De Carvallo JR (1997) New techniques for construction of efferent conduits based on the Mitranoff principle. Urology 49:112-115

    Article  PubMed  CAS  Google Scholar 

  • Nieminen K, Hiltunen K, Laitinen J, Oksala J, Heinonen P (2003) Transanal or vaginal approach to Rectocele repair; results of prospective randomized study. Neurourol Urodyn 22:547-548

    Google Scholar 

  • Ommer A, Albrecht K, Wenger F, Walz MK (2006) Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome. Langenbecks Arch Surg 391(1):32-37

    Article  PubMed  CAS  Google Scholar 

  • Papen Von, Michael Ashari, Luai HS, Lumley JohnW et al (2006) Functional results of laparoscopic resection rectopexy for symptomatic rectal intussusception. Dis Colon Rectum 50:50-55

    Article  Google Scholar 

  • Paraiso MF, Barber MD, Muir TW, Walters MD (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195(6):1762-1771

    Article  PubMed  Google Scholar 

  • Pescatori M, Boffi F, Russo A, Zbar AP (2006) Complications and recurrence after excision of rectal internal mucosal prolapse for obstructed defecation. Int J Colorectal Dis 21:160-165

    Article  PubMed  CAS  Google Scholar 

  • Poirier M, Abcarian H, Nelson R (2007) Malone antegrade continent enema: an alternative to resection in severe defecation disorders. Dis Colon Rectum 50(1):22-28

    Article  PubMed  CAS  Google Scholar 

  • Portier G, Iovino F, Lazorthes F (2006) Surgery for rectal prolapse: Orr-Loygue ventral rectopexy with limited dissection prevents postoperative induced constipation without increasing recurrence. Dis Colon Rectum 49(8):1136-1140

    Article  PubMed  Google Scholar 

  • Preston DM, Lennard -Jones JE, Thomas BM (1985) Towards a radiologic definition of idiopathic megacolon. Gastrointest Radiol 10:167-169

    Article  PubMed  CAS  Google Scholar 

  • Rao SS, Seaton K, Miller M et al (2007) Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dysnergic defecation. Clin Gatroenterol Hepatol 5:331-338

    Article  Google Scholar 

  • Renzi A, Izzo D, Di Sarno G, Izzo G (2006) Di Martino N Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele. Int J Colorectal Dis 21(7):661-667

    Article  PubMed  CAS  Google Scholar 

  • Renzi A, Talento P, Giardiello C, Angelone G, Izzo D, Di Sarno G (2008) Stapled trans-anal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study. Int J Colorectal Dis 23(10): 999-1005

    Article  PubMed  Google Scholar 

  • Scarpa M, Barollo M, Keighley MR (2005) Ileostomy for constipation: long term post operative outcomes. Colorectal Dis 7(3):224-227

    Article  PubMed  CAS  Google Scholar 

  • Schultz I, Mellgren A, Dolk A, Johansson C, Holmstrom B (2000) Long-term results and functional outcome after Ripstein rectopexy. Dis Colon Rectum 43:35-43

    Article  PubMed  CAS  Google Scholar 

  • Sinha CK, Grewal A, Ward HC (2008) Antegrade continence mechanism (ACE): current practice. Pediatr Surg Int 24(6):658-658

    Article  Google Scholar 

  • Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89(1): 35-39

    Article  PubMed  CAS  Google Scholar 

  • Speakman CTM, Madden MV, Nicholls RJ, Kamm MA (1991) Lateral ligament division during rectopexy causes constipation but prevent recurrence: results of a prospective randomized study. Br J Surg 78:1431-1433

    Article  PubMed  CAS  Google Scholar 

  • Stabile G, Kamm MA, Phillips RK et al (1992) Partial colectomy and coloanal anastomosis for idiopathic megarectum and megacolon. Dis Colon Rectum 35:158-162

    Article  PubMed  CAS  Google Scholar 

  • Stewart J, Kumar D, Keighley MR (1994) Results of anal or low rectal anstomosis and pouch construction for megarectum and megacolon. Br J Surg 81:1051-1053

    Article  PubMed  CAS  Google Scholar 

  • Teichman JM, Harris JM, Currie DM, Barber DB (1998) Malone antegrade continence mechanism for adults with neurogenic bowel disease. J Urol 160:1278-1281

    Article  PubMed  CAS  Google Scholar 

  • Tjandra JJ, Ooi BS, Tang CL et al (1999) Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus. Dis Colon Rectum 42:1544-1549

    Article  PubMed  CAS  Google Scholar 

  • Tsiaoussis John, Chrysos Emmanuel, Athanasakis Elias, et al (2005) Rectoanal intussusception: presentation of the disorder and late results of resection rectopexy. Dis Colon Rectum 48:838-844

    Article  PubMed  Google Scholar 

  • Varma MG, Hart SL, Brown JS, Creasman JM, Van Den Eeden SK, Thom DH (2008) Obstructive defecation in middle- aged women. Dig Dis Sci 53:2702-2709

    Article  PubMed  Google Scholar 

  • Wald Arnold (2001) Outlet dysfunction constipation. Curr Treat Options Gastroenterol 4:293-297

    Article  PubMed  Google Scholar 

  • Willams NS, Hughes SF, Stuchfield B (1994) Continent colonic conduit for rectal evacuation in severe constipation. Lancet 343(8909):1321-1324

    Article  Google Scholar 

  • Woodward MN, Foley P, Cusick EL (2004) Colostomy for treatment of functional constipation in children: a preliminary report. J Petiatr Gastroenterol Nutr 38(1):75-78

    Article  Google Scholar 

  • Worsoe J, Christensen P, Krogh K, Buntzen S, Laurberg S (2008) Long-term results of antegrade colonic enema in adult patients: assessment of functional results. Dis Colon Rectum 51(10):1523-1528

    Article  PubMed  CAS  Google Scholar 

  • Yu DH, Rg Meng, Li Sz (1989) Puborectalis syndrome: a cause of obstinate constipation. Zhonghua Yai Ke Zhi 27:267-268

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Colon and Rectal Department, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Brooke H. Gurland MD, FACS, FASCRS

Authors
  1. Brooke H. Gurland MD, FACS, FASCRS
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. University of New England, Tamworth, NSW, 2340, Australia

    Andrew P. Zbar

  2. Dept. Colorectal Surgery, Cleveland Clinic Florida, Cleveland Clinic Blvd. 2950, Weston, 33331, USA

    Steven D. Wexner

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag London Limited

About this chapter

Cite this chapter

Gurland, B.H. (2010). The Surgical Management of Evacutory Dysfunction. In: Zbar, A., Wexner, S. (eds) Coloproctology. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84882-756-1_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-756-1_11

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-755-4

  • Online ISBN: 978-1-84882-756-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation