Anorectal functional disorders
Anorectal functional disorders
The first part of this thesis van Jenneke Kalkdijk consists of a systematic review and meta-analysis assessing the coprevalence of functional constipation and dyssynergic defecation in patients with hemorrhoids. Results show that functional constipation, dyssynergia, and higher basal anal pressures are significantly more common in patients with hemorrhoids than in healthy controls. Straining often preceded hemorrhoid symptoms. Treating constipation, dyssynergia, and high anal pressure may reduce straining, improve defecation, and lead to better long-term outcomes with lower recurrence rates.
A clinical study involving 63 patients further explored the prevalence of dyssynergic defecation and functional constipation. Anal manometry revealed dyssynergic patterns in 92.1% of patients. Pain during defecation was associated with previous surgery, female gender, and squeezing during defecation. Increased awareness is essential for timely diagnosis and conservative treatment, especially in cases of recurrence or prolonged symptoms.
The second part of the thesis focused on a multicenter randomized controlled trial investigating pelvic floor rehabilitation (PFR) versus usual care in patients with functional complaints after rectal cancer surgery. PFR did not significantly improve outcomes in unselected patients. However, those with urgency or moderate incontinence showed significant improvement, suggesting a selective referral strategy may benefit 65–85% of patients.
An implementation study identified barriers to PFR adoption, including lack of guidelines, fragmented care, poor patient education, and limited insurance coverage. Enablers included existing evidence supporting PFR, strong patient-therapist relationships, and high patient motivation.