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?

Colorectal Dis. 2013 Nov;15(11):e680-5. doi: 10.1111/codi.12367.

Abstract

Aim: Pelvic floor retraining is considered first-line treatment for patients with faecal incontinence or obstructed defaecation. There are at present no data on the effect of a high grade internal rectal prolapse on outcomes of pelvic floor retraining. The current study aimed to assess this influence.

Method: In all, 120 consecutive patients were offered pelvic floor retraining. The predominant symptom was faecal incontinence in 56 patients (47%) and obstructed defaecation in 64 patients (53%). Patients were assessed before and after therapy using the Fecal Incontinence Severity Index (FISI), the Patient Assessment of Constipation Symptoms (PAC-SYM) score and the Gastrointestinal Quality of Life Index (GIQLI). Defaecography and anorectal manometry were performed in all patients before pelvic floor retraining.

Results: A high grade internal rectal prolapse was observed in 42 patients (35%). In patients with faecal incontinence without a high grade internal rectal prolapse, 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 rectal prolapse. The PAC-SYM score improved significantly (24 vs 19; P = 0.01) in patients with obstructed defaecation without a high grade rectal prolapse compared with no significant change (26 vs 25; P = 0.21) in patients with a high grade rectal prolapse. Quality of life (GIQLI) improved only in patients without a high grade internal rectal prolapse.

Conclusion: Pelvic floor retraining may be useful in patients with defaecation disorders not associated with a high grade internal rectal prolapse. Patients with a high grade internal rectal prolapse may be considered for surgery from the outset.

Keywords: Constipation; biofeedback; faecal incontinence; internal rectal prolapse; obstructed defaecation.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Aged
  • Anal Canal / physiopathology
  • Defecation / physiology
  • Defecography
  • Exercise Therapy*
  • Fecal Incontinence / complications
  • Fecal Incontinence / diagnostic imaging
  • Fecal Incontinence / therapy*
  • Female
  • Humans
  • Male
  • Manometry
  • Middle Aged
  • Pelvic Floor / physiopathology*
  • Quality of Life
  • Rectal Prolapse / complications*
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome