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[Treatment of functional diseases after rectum anal surgery: effectiveness of rehabilitation of the pelvic pavement].

Abstract

AIM

Anorectal dysfunction is routinely treated at the Center for Pelvic Floor Rehabilitation, San Giovanni University Hospital, Turin, Italy. Of a total of 147 patients treated between April 2007 and May 2008, 44 (30%) received pelvic floor rehabilitation following anorectal surgery. With this study we wanted to evaluate the response of patients with constipation and/or fecal incontinence to postsurgical pelvic floor rehabilitation designed to regain full or partial anorectal function and so improve their quality of life.

MATERIAL AND METHODS

The study population was 44 patients, subdivided into 3 groups. One group (n=25) consisted of patients with fecal incontinence, which was further split into two subgroups: subgroup A (n=10) with direct involvement of the anal sphincter at surgery and subgroup B (n=15) without sphincter involvement. The second group (n=12) included patients with constipation. The third group (n=7) included patients with constipation and incontinence; this group was further split into 2 subgroups: those in which constipation (n=5) and those in which incontinence (n=2) was predominant. Pre- and postrehabilitation anorectal function was compared using two types of assessment: 1) clinical evaluation with the Wexner incontinence scale and 2) diagnostic evaluation with anorectal manometry in patients with fecal incontinence (plus transanal sonography to determine anatomic damage in the subgroups in which the sphincter had been involved) and defecography in those with constipation (plus transit radiography to exclude intestinal colic-associated constipation).

RESULTS

The number of patients classified as having severe incontinence decreased from 8 to 1 (-87.5%), those with moderate incontinence decreased from 8 to 4 (-50%); 20 out of 25 patients presented with mild dysfunction at the end of the rehabilitation program. No difference in response to treatment was found between the two subgroups of patients with fecal incontinence nor among those with constipation. Of those with predominant constipation, none were classified as having severe dysfunction; the number of those with moderate dysfunction decreased from 13 to 7 (-54%).

CONCLUSIONS

The study results show that, when sufficiently motivated, patients with fecal incontinence and constipation following anorectal surgery respond positively to pelvic floor rehabilitation.

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  • Authors+Show Affiliations

    ,

    Clinica Chirurgica, Azienda Ospedaliero-Universitaria S. Giovanni Battista di Torino, Torino, Italia.

    , , ,

    Source

    Minerva chirurgica 64:2 2009 Apr pg 197-203

    MeSH

    Anus Diseases
    Biofeedback, Psychology
    Constipation
    Defecography
    Digestive System Surgical Procedures
    Electric Stimulation
    Exercise Therapy
    Fecal Incontinence
    Humans
    Italy
    Manometry
    Pelvic Floor
    Prevalence
    Quality of Life
    Recovery of Function
    Rectal Diseases
    Retrospective Studies
    Severity of Illness Index
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    English Abstract
    Journal Article

    Language

    ita

    PubMed ID

    19365320

    Citation

    Corno, F, et al. "[Treatment of Functional Diseases After Rectum Anal Surgery: Effectiveness of Rehabilitation of the Pelvic Pavement]." Minerva Chirurgica, vol. 64, no. 2, 2009, pp. 197-203.
    Corno F, Volpatto S, Borasi A, et al. [Treatment of functional diseases after rectum anal surgery: effectiveness of rehabilitation of the pelvic pavement]. Minerva Chir. 2009;64(2):197-203.
    Corno, F., Volpatto, S., Borasi, A., Barberis, A., & Mistrangelo, M. (2009). [Treatment of functional diseases after rectum anal surgery: effectiveness of rehabilitation of the pelvic pavement]. Minerva Chirurgica, 64(2), pp. 197-203.
    Corno F, et al. [Treatment of Functional Diseases After Rectum Anal Surgery: Effectiveness of Rehabilitation of the Pelvic Pavement]. Minerva Chir. 2009;64(2):197-203. PubMed PMID: 19365320.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - [Treatment of functional diseases after rectum anal surgery: effectiveness of rehabilitation of the pelvic pavement]. AU - Corno,F, AU - Volpatto,S, AU - Borasi,A, AU - Barberis,A, AU - Mistrangelo,M, PY - 2009/4/15/entrez PY - 2009/4/15/pubmed PY - 2009/9/18/medline SP - 197 EP - 203 JF - Minerva chirurgica JO - Minerva Chir VL - 64 IS - 2 N2 - AIM: Anorectal dysfunction is routinely treated at the Center for Pelvic Floor Rehabilitation, San Giovanni University Hospital, Turin, Italy. Of a total of 147 patients treated between April 2007 and May 2008, 44 (30%) received pelvic floor rehabilitation following anorectal surgery. With this study we wanted to evaluate the response of patients with constipation and/or fecal incontinence to postsurgical pelvic floor rehabilitation designed to regain full or partial anorectal function and so improve their quality of life. MATERIAL AND METHODS: The study population was 44 patients, subdivided into 3 groups. One group (n=25) consisted of patients with fecal incontinence, which was further split into two subgroups: subgroup A (n=10) with direct involvement of the anal sphincter at surgery and subgroup B (n=15) without sphincter involvement. The second group (n=12) included patients with constipation. The third group (n=7) included patients with constipation and incontinence; this group was further split into 2 subgroups: those in which constipation (n=5) and those in which incontinence (n=2) was predominant. Pre- and postrehabilitation anorectal function was compared using two types of assessment: 1) clinical evaluation with the Wexner incontinence scale and 2) diagnostic evaluation with anorectal manometry in patients with fecal incontinence (plus transanal sonography to determine anatomic damage in the subgroups in which the sphincter had been involved) and defecography in those with constipation (plus transit radiography to exclude intestinal colic-associated constipation). RESULTS: The number of patients classified as having severe incontinence decreased from 8 to 1 (-87.5%), those with moderate incontinence decreased from 8 to 4 (-50%); 20 out of 25 patients presented with mild dysfunction at the end of the rehabilitation program. No difference in response to treatment was found between the two subgroups of patients with fecal incontinence nor among those with constipation. Of those with predominant constipation, none were classified as having severe dysfunction; the number of those with moderate dysfunction decreased from 13 to 7 (-54%). CONCLUSIONS: The study results show that, when sufficiently motivated, patients with fecal incontinence and constipation following anorectal surgery respond positively to pelvic floor rehabilitation. SN - 0026-4733 UR - https://www.unboundmedicine.com/medline/citation/19365320/[Treatment_of_functional_diseases_after_rectum_anal_surgery:_effectiveness_of_rehabilitation_of_the_pelvic_pavement]_ L2 - http://www.minervamedica.it/index2.t?show=R06Y2009N02A0197 DB - PRIME DP - Unbound Medicine ER -