SHOULD PATIENTS WITH COMBINED COLONIC INERTIA AND NONRELAXING PELVIC FLOOR UNDERGO SUBTOTAL COLECTOMY

PURPOSE: Treatment of severe constipation caused by combined colonic i nertia and nonrelaxing pelvic floor is controversial. This study is de signed to evaluate the outcome of preoperative biofeedback and subtota l colectomy for patients with combined colonic inertia and nonrelaxing pelvic floor. METHODS: One hundred six patients who underwent subtota l colectomy for intractable constipation from 1982 through 1995 answer ed a detailed questionnaire regarding postoperative bowel function, sy mptoms of abdominal pain and bloating, and degree of satisfaction afte r the operation. Sixteen of these patients had a combination of coloni c inertia and nonrelaxing pelvic floor diagnosed by transit marker stu dy, electromyography, and defecography. These patients completed preop erative biofeedback training. RESULTS: Electromyographic relaxation of pelvic Boor musculature was demonstrated after the biofeedback treatm ent in all patients, but symptoms of difficult evacuation persisted. P ostoperatively, seven patients (43 percent) had complete resolution of symptoms of constipation or difficult evacuation. Six patients still complained of incomplete evacuation that was severe in two and unrespo nsive to postoperative biofeedback. Three patients (18 percent) compla ined of diarrhea (>5 bowel movements per day) and incontinence of liqu id stools (at least one episode a week). Nine patients (56 percent) we re satisfied despite persistent symptoms. CONCLUSIONS: Subtotal colect omy can improve some symptoms in patients with slow transit constipati on and nonrelaxing pelvic floor. However, incomplete evacuation persis ts in a significant number of patients and almost one-half of patients are dissatisfied with their surgery.