Diagnostic and therapeutic challenges in the management of obstructive defecation.

We present the case of a 53-year-old woman with life-long constipation complicated by a solitary rectal ulcer. In these cases it is always necessary to evaluate the presence of evacuation disorder, both functional (dyssynergic defecation) and anatomical. An exhaustive clinical history and physical examination that includes a dynamic rectal examination are essential. Currently, anorectal manometry is the study of choice for functional anorectal evaluation accompanied by the balloon expulsion test. When the results of both techniques are disagreed, a third diagnostic test is required, such as defecography that will confirm the dyssynergic defecation and/or the presence of important anatomical lesions, as in the case of the patient we present. These cases do not normally respond to conservative treatment only, requiring surgical repair of the prolapsed organs, with the aid of rehabilitative techniques that help to carry out a complete and adequate defecatory maneuver. This case reflects the diagnostic doubts, uncertainty and the complex management of these patients, which must be addressed by a multidisciplinary team. PMID: 33397119 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research