Surgery should not be default for rectoceles
medwireNews: Researchers have found no difference in anorectal physiology or severity of obstructed defecation syndrome (ODS) between patients with and without rectoceles.
The findings indicate that rectoceles, commonly thought to be a cause of ODS, are in fact a symptom of the condition. The study authors say the finding may explain why surgery to repair rectoceles alone is often ineffective in resolving ODS, as it fails to address the underlying pelvic dysfunction.
"We recommend that patients considered for surgery for rectoceles due to ODS should first undergo appropriate bowel retraining," say Liliana Bordeianou (Massachusetts General Hospital, Boston, USA) and colleagues.
The study involved 239 female patients who were diagnosed with ODS on the basis of symptoms including incomplete or fragmented defecation or straining during defecation. Overall, 90 (37.7%) of these patients had rectoceles.
The authors found no significant differences between patients with and without rectoceles on the basis of anorectal manometry results, and observed similar rates of pelvic floor dyssynergia and similar symptom severity between the groups.
However, they note that only patients with rectoceles reported splinting to aid defecation (36.7 vs 0% patients without rectoceles).
And, in regression analyses, a patient's inability to expel a 60 mL balloon by defecation was the only factor associated with a higher odds for rectoceles (odds ratio=3.0; 70.1 vs 57.5% patients without rectoceles).
"There is no evidence to suggest that rectoceles precede ODS, or cause an increased severity of disease," Bordeianou and colleagues write in Colorectal Disease.
They say that their findings could be important in determining the optimum treatment for rectoceles. If ODS is caused by rectoceles, then surgical correction should treat the constipation. If, however, rectoceles are a symptom of ODS, then surgery without treating underlying pelvic dysfunction will inevitably lead to relapse, they say.
Their findings coupled with a previously observed relapse rate of 50% within 3 years of surgery suggest this is the case, they say.
Further research will be needed but the authors conclude that "it is possible that by combining anatomical correction with medical and biofeedback therapy, the risk of rectocele recurrence following surgery may be reduced."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter