RT Book, Section
A1 Dunivan, Gena
A1 Whitehead, William
A2 Rogers, Rebecca G.
A2 Sung, Vivian W.
A2 Iglesia, Cheryl B.
A2 Thakar, Ranee
SR Print(0)
ID 1105830015
T1 Defecatory Dysfunction
T2 Female Pelvic Medicine and Reconstructive Surgery: Clinical Practice and Surgical Atlas
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-175641-9
LK obgyn.mhmedical.com/content.aspx?aid=1105830015
RD 2024/04/19
AB Defecatory  dysfunction  is  an  ill-defined  term  that  encompasses  a  broad  range  of  symptoms  related  to  infrequent  or  hard  stools  and  difficult  or  incomplete  evacuation  of  the  rectum.  Patients  generally  lump  these  together  and  think  of  them  collectively  as  symptoms  of  “constipation;”  when  healthy  young  adults  were  asked  what  they  mean  by  “constipation,”  they  referred,  in  descending  order  of  frequency,  to  straining,  hard  stools,  “want  to  but  can’t,”  infrequent  stools,  abdominal  discomfort,  and  “haven’t  finished.”1  Unfortunately,  the  symptoms  reported  by  patients  are  not  a  reliable  guide  to  the  pathophysiologic  basis  of  their  symptoms  or  the  choice  of  optimal  treatment.  Consequently,  the  Rome  Foundation2  recommended  a  two-tiered  basis  for  evaluating  constipation:  Patients  are  first  asked  how  many  of  six  commonly  reported  symptoms  of  constipation  they  experience  at  least  25%  of  the  time,  and  if  they  endorse  two  or  more  of  these  symptoms  and  rarely  experience  diarrhea,  they  are  said  to  have  clinically  significant  or  “functional”  constipation  (Table  10-1).  If  patients  meet  these  symptom  criteria  for  functional  constipation  and  fail  to  respond  to  a  trial  of  conservative  treatment  and  laxatives,  physiologic  testing  is  recommended  to  further  define  the  pathophysiologic  basis  of  their  constipation  and  to  choose  an  appropriate  treatment.