Chronic constipation is a disorder that affects approximately 15% of the population, the majority of them being women. Constipation occurs when bowel movements become either difficult or less frequent. Most of the time, chronic constipation can be relieved with a combination of diet, exercise and medication. However, if medical therapy fails, a causative factor may be the Obstructed Defecation Syndrome (ODS).
ODS is characterized by prolonged straining, use of digital means to evacuate, sense of incomplete evacuation and pelvic pressure. The symptoms these patients suffer have historically been attributed to a rectocele. However, we have now come to understand that the symptoms result from altered force development during defecation. Failure to address the dysfunction of the rectal muscle leads to treatment failure. Clinical findings include perineal descent, rectocele and/or internal mucosal prolapse. Those who suffer from ODS may be candidates for the STARR procedure.
STARR is a new surgical procedure that may alleviate symptoms and address the dysfunctional rectal muscle. It is a surgical procedure that is performed through the anus and leaves no visible scars. Using a circular stapler, the procedure removes excess tissue in the rectum and reduces deformities than can cause ODS. There is very minimal recovery time and patients usually require only an overnight hospital stay.
Recent clinical studies have indicated very high success rates in those patients who suffer from ODS treated by the STARR procedure, with approximately 90% of patients rating the results as either good or excellent.1 Several of these procedures have been performed by trained surgeons at the Ferguson Clinic/mmpc, and initial results are very promising.
Those who suffer from chronic constipation not alleviated by medical means may actually suffer from ODS. A thorough history and physical exam will help identify those with ODS who may benefit from the STARR procedure.
Physicans that perform this procedure inlcude Drs. Hoedema, Kim and Senagore.
Reference:
1. Boccasanta P, Venturi M, Stuto A et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multi-center trial. Dis Colon Rectum 2004; 47: 1285-96.
