Case Report

Persistent dyschezia after double stapled transanal rectal resection for outlet obstruction: four case reports


Pelviperineology 2007;26(3):132-135

Sometimes dyschezia may be due to rectocele and/or recto-anal intussusception. Stapled transanal rectal resection (STARR) is a surgical option for dyschezia caused by rectocele and/or recto-anal intussusception. We reported four cases of patients evaluated for persistent symptoms of impaired defecation after STARR. Goals of the study were to identify the causes of failure, to outline an effective rehabilitative treatment program and to evaluate the post-rehabilitation results. Four females (mean age: 48.5 ± 3.3 years old), who had a previous STARR and who were symptomatic for dyschezia, underwent clinical evaluation, defecography, and anorectal manometry. A rehabilitative treatment was successively planned on the basis of the diagnostic instrumental data. A post-rehabilitative clinical evaluation was performed and the instrumental data of patients were compared with those of ten healthy women (mean age 54 years, range 43-67) with normal bowel habits. Clinical evaluation, defecographic X-rays, and anorectal manometry made diagnosis of outlet obstruction, supported by pelvic floor dyssynergia. The pelvic floor dyssynergia was also preoperatively present in all patients. An appropriate cycle of rehabilitation was outlined for each patient. After the rehabilitation the patients were clinically evaluated and Agachan constipation score lowered in all 4 cases. The persistent dyschezia after STARR was caused by pelvic floor dyssynergia, which was present pre-operatively. Rehabilitation was a useful therapeutic option in these patients.

Keywords: Obstructed defecation; Chronic constipation; Rehabilitation; Biofeedback.