Department of Surgery, Nepean Hospital, Sydney, New South Wales, Australia.
South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia.
ANZ J Surg. 2023 May;93(5):1253-1256. doi: 10.1111/ans.18200. Epub 2022 Dec 9.
Rectal intussusception is often observed in patients with faecal incontinence and obstructed defaecation. The aim of this study is to assess if pelvic floor training improves faecal incontinence and obstructed defaecation in patients with rectal intussusception.
Case notes of all patients referred to Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018 for the management of faecal incontinence and obstructed defaecation and rectal intussusception were retrospectively reviewed using a prospectively maintained database. St Mark's faecal incontinence and Cleveland clinic constipation scores were obtained from patients before and after they underwent pelvic floor training.
One hundred and thirty-one patients underwent pelvic floor training at Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018. Sixty-one patients had rectal intussusception (22 low-grade and 39 high-grade). Median St Marks score improved following pelvic floor training from 8 to 1 (P < 0.001). Median Cleveland Clinic constipation score improved from 8 to 5 (P < 0.001). In patients with low grade rectal intussusception, pelvic floor training improved median St Mark's score from 3 to 0 (P = 0.003), whereas Cleveland Clinic constipation score improved from 9 to 7 (P < 0.001). In patients with high-grade rectal intussusception, pelvic floor training improved median St Mark's score from 9 to 2 (P < 0.001), whereas median Cleveland Clinic constipation score improved from 8 to 4 (P < 0.001).
Pelvic floor training without biofeedback therapy improves faecal incontinence and obstructed defaecation. Improvement in symptoms is unrelated to rectal intussusception observed on proctography or at examination under anaesthesia in these patients.
直肠套叠在粪便失禁和排便困难的患者中经常观察到。本研究旨在评估盆底训练是否能改善直肠套叠患者的粪便失禁和排便困难。
使用前瞻性维护的数据库，回顾性分析了 2013 年至 2018 年间因粪便失禁和排便困难以及直肠套叠转诊至 Bankstown 医院盆底诊所的所有患者的病历。在接受盆底训练前后，从患者那里获得 St Mark 的粪便失禁和克利夫兰诊所便秘评分。
2013 年至 2018 年间，131 名患者在 Bankstown 医院盆底诊所接受了盆底训练。61 例患者有直肠套叠（22 例低级别和 39 例高级别）。盆底训练后，St Marks 评分中位数从 8 分提高到 1 分（P<0.001）。克利夫兰诊所便秘评分中位数从 8 分提高到 5 分（P<0.001）。在低级别直肠套叠患者中，盆底训练将 St Mark's 评分中位数从 3 分提高到 0 分（P=0.003），而克利夫兰诊所便秘评分从 9 分提高到 7 分（P<0.001）。在高级别直肠套叠患者中，盆底训练将 St Mark's 评分中位数从 9 分提高到 2 分（P<0.001），而克利夫兰诊所便秘评分从 8 分提高到 4 分（P<0.001）。
无生物反馈治疗的盆底训练可改善粪便失禁和排便困难。在这些患者中，直肠套叠在直肠造影或麻醉下检查中观察到的症状改善与直肠套叠无关。
