Rectocele repair in women with obstructed defecation

Abstract

Constipation is a symptom of many diseases of mixed origins and mechanisms. Although endocrine, metabolic, pharmacological, psychogenic and organic abnormalities may playa role in the pathogenesis of constipation, it is widely accepted that the main causes of constipation are a low fiber intake and sedentary work. Size of stool and stool consistency, decreased defecation frequency and obstructed defecation have been used to defllle constipation. However, size and consistency of stool are impractical to quantifY, and although obstructed defecation has been dermed as straining during attempted defecation in more than 25 percent of the time, this definition is limited by its subjectivityl", Defecation frequency is the most easy parameter to evaluate and it is generally accepted that in western cotUltries a 'nonnal! defecation frequency is three or more times per week, If the criterion of defecation frequency is applied, the estimated prevalence of constipation in the United States is two percent3 , Besides differences in prevalence of constipation in different age groups and different cultures, gender plays an important role, Studies of patients with severe constipation show that women comprise the overwhelming majority of patients, in aging people, women being three times more affected than men3 - S • Many subjects with constipation can be managed by simple measurements such as dietary changes, increased fluid intake, addition of bulk, regular physical exercise and use of laxatives and stool softeners. When these measurements are not successful and no causative abnormalities can be detected by conventional investigative procedures, further evaluation is necessary, as surgical treatment might be a therapeutic option