Annals of Coloproctology

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Case Reports

Benign bowel disease

Colonic duplication in an adult with chronic constipation: a case report and review of its surgical management: Muhammad Ash-Shafhawi Adznan, Hizami Amin Tai, Aras Emre Canda, Nevra Elmas, Mustafa Cem Terzi; Ann Coloproctol. 2024;40(Suppl 1):S6-S10. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.01081.0154

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One of the possible causes of chronic constipation is colonic duplication. Although seldom asymptomatic, its diagnosis is important due to the risk of malignancy that it carries. We present a case of a young female patient with long-standing constipation who was referred to Kolorektal Cerrahi Clinic (Izmir, Turkey) after scans revealed tubular type of colonic duplication. We successfully performed a laparoscopic total colectomy, and she recovered well. Identifying the type of duplication is important to ensure adequate resection and treatment. A proper workup, including carcinoembryonic antigen levels, must be done as well. Multiple surgical techniques and procedures have been introduced for this condition, but resection of the duplicated colon with its native lumen should be the management of choice, especially in tubular type of duplications such as in our case. In centers where laparoscopic services are available, laparoscopy could be a better option, as it provides multiple benefits of minimally invasive surgery. Attention should also be paid to anatomical details during surgery to ensure better results and outcomes.

Citations

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Tubular duplication of colon with diverticulosis in an adult
Pinaki Saoji, Shrishail Adke, Ajith Varrior
Journal of Applied & Clinical Radiology.2025; 1(2): 67. CrossRef

Benign bowel disease

A case report of a giant solitary juvenile polyp: from obstructed defecation syndrome to incontinence: Zhan Huai Teoh, Jien Yen Soh, Nasibah Mohamad, Norzaliana Zawawi, Andee Dzulkarnaen Zakaria, Zaidi Zakaria, Michael Pak-Kai Wong; Ann Coloproctol. 2024;40(Suppl 1):S27-S31. Published online November 25, 2022; DOI: https://doi.org/10.3393/ac.2022.00549.0078

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Abstract PDF: Juvenile polyps (JPs) are the most common polyps in pediatric patients. We present the case of an 18-year-old male patient with a giant solitary JP resembling solitary rectal ulcer syndrome (SRUS). The presenting history was rectal bleeding and symptoms of obstructed defecation syndrome. Colonoscopy revealed a polypoidal mass at the anorectal junction, with biopsy-confirmed SRUS. The symptoms worsened, and a protruding mass from the anus caused fecal incontinence. Pelvic magnetic resonance imaging showed a huge pedunculated mass occupying the low rectum with local compression of the urinary bladder. Transanal excision of the anal tumor was performed due to bleeding. A histopathological examination showed a JP with high-grade dysplasia. A histological examination to differentiate JPs and SRUS could be challenging based on a superficial forceps biopsy. Therefore, an excision biopsy is usually warranted with the understanding that adenomatous or malignant transformation is found in 5.6% to 12% of all JPs.

Original Articles

Annual long-term functional outcomes after transanal repair for symptomatic rectocele: Akira Tsunoda, Hiroshi Kusanagi; Received April 22, 2022 Accepted July 7, 2022 Published online November 15, 2022; DOI: https://doi.org/10.3393/ac.2022.00283.0040 [Epub ahead of print]

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Abstract PDF

Purpose
This study was performed to assess the long-term annual functional outcomes and quality of life (QOL) after transanal rectocele repair.
Methods
We evaluated retrospectively collected data from patients who underwent transanal repair for symptomatic rectocele between February 2012 and December 2018. The Constipation Scoring System (CSS), the Fecal Incontinence Severity Index (FISI), and several QOL questionnaires (e.g., the Patient Assessment of Constipation-QOL [PAC-QOL], Fecal Incontinence QOL, and the 36-Item Short Form Survey [SF-36]) were administered before surgery and annually after surgery. Additionally, physiological assessments and defecography were performed before and after surgery. Substantial symptom improvement, indicated by at least a 50% reduction in the CSS or FISI score, was evaluated postoperatively. All postoperative follow-up results were compared with the preoperative data.
Results
Thirty-two patients were included in the study. The median follow-up period was 5 years (range, 0.5−7 years). Postoperative defecography showed that the rectocele size significantly decreased (P<0.0001). However, the physiological assessment did not reveal postoperative changes. The CSS score 1 year after surgery was significantly lower than the preoperative score (P<0.0001) and remained significantly low until the long-term follow-up. Constipation improved by more than 80% 2 to 5 years postoperatively, and fecal incontinence improved in 2/3 of the patients after 5 years. The PAC-QOL scores significantly improved (all P<0.05) over time until the 3-year and long-term follow-ups, and 6 of the 8 SF-36 scores significantly improved at specific points postoperatively.
Conclusion
Transanal rectocele repair provides long-term improvement for constipation and constipation-specific QOL.

Citations

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IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles
Suneetha Rachaneni, Hans Peter Dietz, Pallavi Latthe, Annie Sirany, Anna Spivak, Anupreet Dua
International Urogynecology Journal.2026; 37(1): 75. CrossRef
Transvaginal repair of rectocele for obstructed defecation syndrome: a case report
Liman Zhang, Jie Yang, Qiang Wang, Lili Wang, Shuzhen Su, Lifang Wang, Shiyuan Li
Journal of Surgical Case Reports.2025;[Epub] CrossRef
Laparoscopic or transanal repair of rectocele? Comparison of a reduction in rectocele size
Akira Tsunoda, Tomoko Takahashi, Satoshi Matsuda, Hiroshi Kusanagi
International Journal of Colorectal Disease.2023;[Epub] CrossRef

Benign proctology

Analyzing the Role of Anal Sphincter Pressure in Rectocele Formation: Süleyman Büyükaşık, Mehmet Abdussamet Bozkurt, Selin Kapan, Halil Alis; Ann Coloproctol. 2020;36(5):330-334. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.15

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3 Citations

Abstract PDF

Purpose
Constipation is a common entity in society with various factors in the etiology. In this study, we evaluated the role of anal sphincter pressure of patients who refer to surgery clinic with complaint of constipation.
Methods
Sixty patients who refer to surgery clinic with complaint of constipation and were diagnosed with constipation due to Rome III criteria between July 2010 and September 2014. These patients were evaluated with defecography and were divided into 2 groups based on presence of rectocele. Both groups’ anal sphincter pressures were evaluated using anal manometry and findings were compared.
Results
The patients with rectocele and without rectocele using defecography were inspected with anal manometry regarding resting tone pressure, squeeze pressure, maximum squeeze pressure and simulated defecation response pressure, first sensation volume, urge sensation volume, and maximum tolerable volume. Results were compared and no significant difference was found regarding groups with rectocele and without rectocele (P > 0.05).
Conclusion
We have proved the hypothesis arguing that increased sphincter pressures do not play a role in the formation of rectocele by inducing an obstruction and the formation of dilation in proximal bowel, and demonstrated that the presence of rectocele is not dependent on an increase in sphincter pressures.

Citations

Citations to this article as recorded by

A possible physiological mechanism of rectocele formation in women
Ge Sun, Robbert J. de Haas, Monika Trzpis, Paul M. A. Broens
Abdominal Radiology.2023; 48(4): 1203. CrossRef
Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report
Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
International Journal of Surgery Case Reports.2022; 98: 107524. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef

Case Report

Bilateral Rotational S Flap Technique for Preventing Restenosis in Patients With Severe Circular Anal Stenosis: A Review of 2 Cases: Yuda Handaya, Mukhamad Sunardi; Ann Coloproctol. 2019;35(4):221-224. Published online February 19, 2019; DOI: https://doi.org/10.3393/ac.2017.10.16

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2 Web of Science
2 Citations

Abstract PDF

Anal stenosis is a late hemorrhoidectomy complication. Sphincterotomy and various anoplasty techniques are used for treatment severe anal stenosis, such as the C flap, House flap, U flap, and rotational S flap, but no procedure is ideal for every patient. We review 2 cases of severe circular anal stenosis. Their complaints included narrow caliber of the stool and feeling unsatisfied defecation. Excision of scar tissue using the circular technique was followed by reconstruction using the bilateral rotational S flap procedure. At the 1-year follow-up, the patient had complaints about neither defecation nor pain, and no longer needed laxative agents. In conclusion, the bilateral rotational S flap technique should be considered as a viable treatment because it can also prevent the occurrence of restenosis, especially given the consideration of adequate blood supply.

Citations

Citations to this article as recorded by

Is anoplasty superior to scar revision surgery for post-hemorrhoidectomy anal stenosis? Six years of experience
Yu-Tse Weng, Kuan-Jung Chu, Kuan-Hsun Lin, Chun-Kai Chang, Jung-Cheng Kang, Chao-Yang Chen, Je-Ming Hu, Ta-Wei Pu
World Journal of Clinical Cases.2022; 10(22): 7698. CrossRef
Anoplasty for anatomical anal stenosis: systematic review of complications and recurrences
Gaetano Gallo, Arcangelo Picciariello, Gian Luca Di Tanna, Patrizia Pelizzo, Donato Francesco Altomare, Mario Trompetto, Giulio Aniello Santoro, Franco Roviello, Carla Felice, Ugo Grossi
Colorectal Disease.2022; 24(12): 1462. CrossRef

Original Article

Laparoscopic Posterolateral Rectopexy for the Treatment of Patients With a Full Thickness Rectal Prolapse: Experience With 63 Patients and Short-term Outcomes: Keehoon Hyun, Shi-Jun Yang, Ki-Yun Lim, Jong-Kyun Lee, Seo-Gue Yoon; Ann Coloproctol. 2018;34(3):119-124. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2018.01.31

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5 Web of Science
5 Citations

Abstract PDF

Purpose
Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients.
Methods
Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients’ satisfaction scores (0–10), and the occurrence of constipation.
Results
No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation.
Conclusion
LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.

Citations

Citations to this article as recorded by

Anatomical and functional outcomes of rectal prolapse treatment with laparoscopic pelvic organ prolapse suspension versus laparoscopic ventral mesh rectopexy
Adel Zeinalpour, Alimohammad Bananzadeh, Mohammad Mostafa Safarpour, Sara Shojaei‐Zarghani, Seyede Saeideh Shahidinia, Seyed Vahid Hosseini, Ali Reza Safarpour
Surgical Practice.2025; 29(1): 26. CrossRef
Surgical outcomes on health-related quality of life in rectal prolapse: A systematic review and meta-analysis
Hannaneh Yousefi-Koma, Yassin Rahnama, Dorsa Najari, Fatemeh Fathabadi, Mojtaba Sedaghat, Alireza Kazemeini, Mohammad Reza Keramati, Amir Keshvari, Mohammad Sadegh Fazeli, Behnam Behboudi, Seyed Mohsen Ahmadi-Tafti
Techniques in Coloproctology.2025;[Epub] CrossRef
Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study
Kwang Dae Hong, Keehoon Hyun, Jun Won Um, Seo-Gue Yoon, Do Yeon Hwang, Jaewon Shin, Dooseok Lee, Se-Jin Baek, Sanghee Kang, Byung Wook Min, Kyu Joo Park, Seung-Bum Ryoo, Heung-Kwon Oh, Min Hyun Kim, Choon Sik Chung, Yong Geul Joh
Annals of Surgical Treatment and Research.2022; 102(4): 234. CrossRef
Laparoscopic Posterolateral Suture Rectopexy for Recurrent Rectal Prolapse in Children
Sherif M. Shehata, Ahmed A. Elhaddad, Wael M. Abo Senna, Mohamed A. Shehat
Journal of Laparoendoscopic & Advanced Surgical Techniques.2019; 29(10): 1292. CrossRef
Changing Trend of Rectal Prolapse Surgery in the Era of the Minimally Invasive Surgery
Suk-Hwan Lee
The Journal of Minimally Invasive Surgery.2019; 22(4): 135. CrossRef

Case Report

Side-to-Side Ileosigmoidostomy Shunting Surgery for the Treatment of Elderly Patients With Chronic Constipation: Yuda Handaya, Agung Maryanto, Marijata; Ann Coloproctol. 2017;33(6):249-252. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.249

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Abstract PDF: Constipation is a digestive disorder that often occurs in the elderly; its main cause is bowel motility disorder. Treatments for patients with chronic constipation include pharmacotherapy, diet changes, and surgery if other therapies do not offer satisfactory results. We describe 4 patients, 2 men (70 and 65 years old) and 2 women (75 and 66 years old), who were diagnosed with chronic constipation (slow transit constipation) and treated with conventional therapy, but did not improve. For that reason, side-to-side ileosigmoidostomy shunting surgery was performed. After the surgery, the average time until normal defecation was 16 days, and the defecation frequency was 3 to 4 times a day with no need for a laxative. No patient had a recurrence of constipation. Based on these results, side-to-side ileosigmoidostomy shunting surgery is expected to restore digestive function and can be considered as an alternative therapy for elderly patients with chronic constipation.

Original Article

Investigation of Clinical Manifestations in Korean Colorectal Cancer Patients: Hye Young Koo, Kyu Joo Park, Jae Hwan Oh, Sung Bum Kang, Seong Taek Oh, Woo Yong Lee; Ann Coloproctol. 2013;29(4):139-143. Published online August 29, 2013; DOI: https://doi.org/10.3393/ac.2013.29.4.139

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Abstract PDF

Purpose

Early diagnostic work-up in patients with clinical symptoms of colorectal cancer (CRC) is important to achieve good treatment results. In this study, we investigated clinical symptoms when a diagnosis of CRC was made in patients who had a surgical resection, especially focusing on the relevance of constipation to CRC.

Methods

The clinical symptoms of 17,415 CRC patients who had curative surgery from January 2010 to December 2012 were collected from 24 training hospitals of surgery.

Results

The number of symptomatic patients before the diagnosis of CRC was 11,085 (63.7%). Hematochezia or melena, abdominal pain, anemia, and constipation were more often found in female than male patients while bowel habit change was more common in male patients. Considering age, bowel habit change and hematochezia or melena were more common in patients younger than 60. Anemia and constipation, however, were more common in patients older than 60. According to the group classification based on age, patients older than 60 had experienced more constipation (P = 0.049). Moreover, patients with constipation tended to have a more advanced disease status (P < 0.001).

Conclusion

In patients who had surgery due to CRC, bleeding, abdominal pain, bowel habit change and constipation were the most frequent symptoms before diagnosis. Although whether or not constipation is a cause of CRC is unclear, it is one of the important clinical symptoms that presents in patients with CRC, and patients with a symptom of constipation tend to present with a more advanced CRC stage.

Citations

Citations to this article as recorded by

Correlation between clinical features, medical history, and lifestyle factors with colorectal cancer stage
Asma Sghaier, Mohamed Amine Elghali, Nouha Haddad, Wassim Dziri, Amal Letaief, Imtinen Belaid, Sabri Youssef
Future Science OA.2025;[Epub] CrossRef
The Role of CT-Quantified Body Composition on Longitudinal Health-Related Quality of Life in Colorectal Cancer Patients: The Colocare Study
Biljana Gigic, Johanna Nattenmüller, Martin Schneider, Yakup Kulu, Karen L. Syrjala, Jürgen Böhm, Petra Schrotz-King, Hermann Brenner, Graham A. Colditz, Jane C. Figueiredo, William M. Grady, Christopher I. Li, David Shibata, Erin M. Siegel, Adetunji T. T
Nutrients.2020; 12(5): 1247. CrossRef
Associations Between Dietary Patterns and Longitudinal Quality of Life Changes in Colorectal Cancer Patients: The ColoCare Study
Biljana Gigic, Heiner Boeing, Reka Toth, Jürgen Böhm, Nina Habermann, Dominique Scherer, Petra Schrotz-King, Clare Abbenhardt-Martin, Stephanie Skender, Hermann Brenner, Jenny Chang-Claude, Michael Hoffmeister, Karen Syrjala, Paul B. Jacobsen, Martin Schn
Nutrition and Cancer.2018; 70(1): 51. CrossRef
Crosstalk between Long Noncoding RNAs and MicroRNAs in Health and Disease
Ahmed Bayoumi, Amer Sayed, Zuzana Broskova, Jian-Peng Teoh, James Wilson, Huabo Su, Yao-Liang Tang, Il-man Kim
International Journal of Molecular Sciences.2016; 17(3): 356. CrossRef
Constipation Risk in Patients Undergoing Abdominal Surgery
Sevim Celik, Nurdan Yalcin Atar, Nilgun Ozturk, Guler Mendes, Figen Kuytak, Esra Bakar, Duygu Dalgiran, Sumeyra Ergin
Iranian Red Crescent Medical Journal.2015;[Epub] CrossRef
Commentary on "Data on the Characteristics and the Survival of Korean Patients With Colorectal Cancer From the Korea Central Cancer Registry"
Mohammad Mohammadianpanah
Annals of Coloproctology.2014; 30(3): 151. CrossRef

Case Report

A Stercoral Perforation of the Rectum: Seung-Jin Kwag, Sang-Kyung Choi, Ji-Ho Park, Eun-Jung Jung, Chi-Young Jung, Sang-Ho Jung, Young-Tae Ju; Ann Coloproctol. 2013;29(2):77-79. Published online April 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.2.77

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Abstract PDF

A stercoral perforation of the rectum due to a fecaloma is a rare disease with a high mortality rate. Although multiple case reports of colonic perforations have been published, the data regarding rectal perforations are limited. This case report will highlight one such case of a stercoral rectal perforation that was successfully treated with a laparoscopic operation.

Citations

Citations to this article as recorded by

Stercoral Colitis: Review of Imaging Features and Complications
Nikitha Karkala, Bertin Mathai, John J. Hines, Sarah Byun, Douglas S. Katz
RadioGraphics.2025;[Epub] CrossRef
Rectal stercoral perforation: an uncommon anatomical localization of a rare surgical emergency
Tom Vandaele, Lisa Dekoninck, Pauline Vanhove, Bart Devos, Mathieu Vandeputte, Marc Philippe, Johan Vlasselaers
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Sepsis de origen abdominal secundaria a perforación estercoral recto-sigmoidea: a propósito de un caso
Juan Daniel Serrano-Lizarazo, María Camila Ayala-Gutiérrez, Diana Clemencia Quintero-Gamboa, Andrea Juliana Pinto-Arias, Juan Paulo Serrano-Pastrana
Revista Médicas UIS.2024;[Epub] CrossRef
The Extremes of Constipation: A Case of Stercoral Perforation From Fecal Impaction in a Teenager
Felicia Lee, Jasmin Cao, Evan Lin, Maho Kurashima, Raymond I Okeke, Christian Saliba, Shin Miyata
Cureus.2023;[Epub] CrossRef
Stercoral re-perforation after colostomy takedown: a case report
Seunghwan Lee, Chang Woo Kim
BMC Surgery.2021;[Epub] CrossRef
Rare but relevant: a systematic review of stercoral perforation
Sherwin Fernando, Diwakar R Sarma
British Journal of Hospital Medicine.2021; 82(4): 1. CrossRef
Pelvic Rectal Stercoral Perforation Resulting in Diffuse Pneumatosis
Anupam K Gupta, Oscar A Vazquez, Miguel Lopez-Viego
Cureus.2020;[Epub] CrossRef
Spontaneous colonic perforation in adults: Evaluation of a pooled case series
Ren Chongxi, Ji Jinggang, Shi Yan, Wang Hongqiao, Liu Yan, Yang Fengshuo
Science Progress.2020;[Epub] CrossRef
Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury
Oshan Basnayake, Chiran Rathnaweera, Umesh Jayarajah, Gishanthan Shanthamoorthy, Heshan Dayantha Siriwardena, Asela Jayathilaka, Paola De Nardi
Case Reports in Surgery.2020; 2020: 1. CrossRef
Stercoral perforation: A rare entity
Nisarg Mehta, Ahan Bhatt, Cici Zhang
World Journal of Colorectal Surgery.2019; 8(4): 114. CrossRef
Stercoral Perforation of the Colon: A Potentially Fatal Complication of Opioid-Induced Constipation
Andrew Davies, Katherine Webber
Journal of Pain and Symptom Management.2015; 50(2): 260. CrossRef
Stercoral Colitis
Maxim Saksonov, Gil N. Bachar, Sara Morgenstern, Abdel-Rauf Zeina, Margarita Vasserman, Orith Protnoy, Ofer Benjaminov
Journal of Computer Assisted Tomography.2014; 38(5): 721. CrossRef

Original Article

Prognostic Factors Associated with Poor Outcome of Biofeedback Therapy for Constipated Patients with Pelvic Outlet Obstruction.: Kim, Sung Jin , Hwang, Yong Hee , Jung, Yong Hwan; J Korean Soc Coloproctol. 2008;24(5):313-321.; DOI: https://doi.org/10.3393/jksc.2008.24.5.313

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Abstract PDF: PURPOSE
The aim of this study was to identify the prognostic factors associated with poor outcome of biofeedback therapy.
METHODS
One hundred thirty-seven (137) constipated patients with pelvic outlet obstruction (median age 49 years) had more than one biofeedback session after defecography. Follow-up data (mean follow-up: 14 months; range: 2~37 months) were obtained in 114 patients. Any differences in demographics, clinical symptoms, and parameters of an anorectal physiological study were evaluated between the success group and the failure group.
RESULTS
At follow-up, 80 (70 percent) patients felt improvement in symptoms, but 34 (30 percent) patients did not. Pre-biofeedback presence of symptoms of difficult defecation predict poor outcome (88 vs. 69 percent for failure vs. success, P<0.05). The positive and the negative predictive values of difficult defecation for poor outcome were 35 percent and 86 percent, respectively. A negative mean pressure change on pre-biofeedback anal manometry was related to a poor outcome (65 vs. 26 percent for failure vs. success, P<0.001). The positive and the negative predictive values of negative mean pressure change for poor outcome were 51 percent and 83 percent, respectively. A negative electrical current change on pre-biofeedback anal electromyography was related to a poor outcome (23 vs. 9 percent for failure vs. success, P<0.05). The positive and the negative predictive values of negative electrical-current change for poor outcome were 53 percent and 74 percent, respectively.
CONCLUSIONS
Difficult defecation, negative mean pressure change in pre-biofeedback anal manometry, and negative electrical current change in pre-biofeedback anal electromyography were predictors associated with poor outcome of biofeedback therapy for constipated patients with pelvic outlet obstruction.

Review

The Roles of Anorectal Physiologic Tests and Treatment of Chronic Constipation.: Hwang, Yong Hee; J Korean Soc Coloproctol. 2008;24(2):148-159.; DOI: https://doi.org/10.3393/jksc.2008.24.2.148

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Abstract PDF: Patients with chronic constipation should be evaluated with physiological tests (defecography and cinedefecography, anal manometry, anal electromyography, and colon transit time) after structural disorders and extracolonic causes have been excluded. In the case of colonic inertia, at first, conservative treatment is necessary. If surgery is indicated, a subtotal colectomy with ileorectal anastomosis is the treatment of choice. Biofeedback is the best option for animus. For patients failing biofeedback, botulinum toxin injection of the puborectalis or sacral nerve stimulation may be indicated. Biofeedback treatment is also considered to be an option for moderate-degree rectoceles, rectal intussusception, and perineal descending syndrome. For the treatment of a severe rectocele, a surgical approach, including transrectal, transvaginal, and transperineal repair or stapled transanal rectal resection (STARR) should be considered. However, the long-term effects of a new technique including botulinum toxin injection, sacral nerve stimulation, and STARR remain to be established.

Original Articles

Effect of Yogurt Enriched Water-soluble Fiber on Functional Constipation.: Huh, Jung Wook , Park, Yoon Ah , Sohn, Seung Kook , Lee, Song Mi , Jung, Eun Joo , Lee, Kang Young , Kim, Sun Jung , Ha, Woel Kyu; J Korean Soc Coloproctol. 2007;23(5):312-320.; DOI: https://doi.org/10.3393/jksc.2007.23.5.312

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10 Citations

Abstract PDF

PURPOSE
Although a diet that is rich in fiber is widely recommended to prevent and treat constipation, the efficacy of fiber supplements with yogurt has not been studied sufficiently. The aim of this study was to evaluate the effect of a yogurt enriched water-soluble fiber on the various symptoms of constipation in female adults with functional constipation.
RESULTS
We did a double-blind and case-controlled study between two groups (placebo vs. fiber group), which were randomly allocated out of 42 subjects with functional constipation by using Rome II criteria. Bowel habits, daily nutritional intakes and physical activities were determined by using a questionnaire, and the segmental colonic transit time was evaluated three times: before treatment, after 4 weeks of treatment, and at the end of the study (2 weeks after treatment).
RESULTS
After 4 weeks of treatment, all defecation symptoms tested, except manual evacuation, showed significant improvements in the fiber group; fiber-enriched yogurt increased the number of bowel movements (P=0.002), reduced the presence of hard stools (P=0.001), improved the frequency of straining (P=0.048), the sense of incomplete evacuation (P= 0.013), and the sense of anorectal obstruction (P= 0.032). The total colonic transit time was shortened after intake of fiber-enriched yogurt (P=0.023). Satisfactory relief was significantly higher in the fiber group (P= 0.011).
CONCLUSIONS
Functional constipation may be improved with water-soluble fiber supplements in yogurt without serious side effects.

Citations

Citations to this article as recorded by

Seoul Consensus on Clinical Practice Guidelines for Functional Constipation
Kyung Ho Song, Young Sin Cho, Jeong Eun Shin, Hye-Kyung Jung, Seon-Young Park, Seung Joo Kang, Jung-Wook Kim, Yoo Jin Lee, Hyun Chul Lim, Hee Sun Park, Seong-Jung Kim, Ra Ri Cha, Ki Bae Bang, Chang Seok Bang, Sung Kyun Yim, Seung-Bum Ryoo, Bong Hyeon Kye,
The Korean Journal of Gastroenterology.2025; 85(3): 319. CrossRef
Laxative effects of prune-fermented drink on loperamide-induced constipation in Sprague-Dawley rats
Wool-Lim Park, Hye-Ji Min, Ji-An Heo, Hwi-Gon Kim, Sang-Hyeon Park, Soon-Jae Kwon, Sang Won Lee, Kwon-Il Seo
Food Science and Preservation.2025; 32(6): 1188. CrossRef
2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation
Young Sin Cho, Yoo Jin Lee, Jeong Eun Shin, Hye-Kyung Jung, Seon-Young Park, Seung Joo Kang, Kyung Ho Song, Jung-Wook Kim, Hyun Chul Lim, Hee Sun Park, Seong-Jung Kim, Ra Ri Cha, Ki Bae Bang, Chang Seok Bang, Sung Kyun Yim, Seung-Bum Ryoo, Bong Hyeon Kye,
Journal of Neurogastroenterology and Motility.2023; 29(3): 271. CrossRef
The Effect of Fiber Supplementation on Chronic Constipation in Adults: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
Alice van der Schoot, Candice Drysdale, Kevin Whelan, Eirini Dimidi
The American Journal of Clinical Nutrition.2022; 116(4): 953. CrossRef
Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition
Jeong Eun Shin, Hye-Kyung Jung, Tae Hee Lee, Yunju Jo, Hyuk Lee, Kyung Ho Song, Sung Noh Hong, Hyun Chul Lim, Soon Jin Lee, Soon Sup Chung, Joon Seong Lee, Poong-Lyul Rhee, Kwang Jae Lee, Suck Chei Choi, Ein Soon Shin
The Korean Journal of Medicine.2016; 91(2): 114. CrossRef
Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition
Jeong Eun Shin, Hye-Kyung Jung, Tae Hee Lee, Yunju Jo, Hyuk Lee, Kyung Ho Song, Sung Noh Hong, Hyun Chul Lim, Soon Jin Lee, Soon Sup Chung, Joon Seong Lee, Poong-Lyul Rhee, Kwang Jae Lee, Suck Chei Choi, Ein Soon Shin
Journal of Neurogastroenterology and Motility.2016; 22(3): 383. CrossRef
Practical Treatments for Constipation in Korea
Kyung-Sik Park, Suck-Chei Choi, Moo-In Park, Jeong-Eun Shin, Kee-Wook Jung, Seong-Eun Kim, Tae-Hee Lee, Hoon-Sup Koo
The Korean Journal of Internal Medicine.2012; 27(3): 262. CrossRef
Diagnosis and Treatment of Constipation
Han Ho Jeon, Hyojin Park
Korean Journal of Medicine.2012; 83(5): 568. CrossRef
Guidelines for the Treatment of Constipation
Moo In Park, Jeong Eun Shin, Seung-Jae Myung, Kyu Chan Huh, Chang Hwan Choi, Sung-Ae Jung, Suck Chei Choi, Chong-Il Sohn, Myung-Gyu Choi
The Korean Journal of Gastroenterology.2011; 57(2): 100. CrossRef
Effects of Routine Haecho Bibimbab Consumption on the Improvement of Bowel Habits during Short Period
Kyung-Dong Cho, Eun Jin Kim, Mi Young Kim, Ok-Hee Baek, Changsun Choi, Chan-Kyu Han, Bog-Hieu Lee
The Korean Journal of Nutrition.2010; 43(1): 34. CrossRef

Effect of Electrical Stimulation and Biofeedback Therapy for Constipated Patients with Impaired Rectal Sensation.: Kim, Young Kyu , Hwang, Yong Hee , Jung, Yong Hwan; J Korean Soc Coloproctol. 2007;23(4):232-236.; DOI: https://doi.org/10.3393/jksc.2007.23.4.232

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Abstract PDF: PURPOSE
Biofeedback therapy is widely used for the management of constipation associated with pelvic outlet obstruction. Some patients have shown poor outcome after biofeedback alone. A subgroup of patients complains of absence of desire to defecate. The main pathophysiology of constipation may be impaired rectal sensation or compliance. This study evaluated the effect of electrical stimulation and biofeedback therapy (EST-BF) for this subgroup of constipated patients with impaired rectal sensation.
METHODS
Of the 37 patients diagnosed with pelvic outlet obstruction by using cinedefecography, 9 patients (M:F=2:7, age=22~77 years, median=57 years) who had impaired rectal sensation (rectal desire threshold > or =100 ml) on anorectal manometry were selected. These patients were treated with EST-BF therapy 2~6 (median: 5) sessions, Kontinece, Multichannel system, HMT, Inc, Seoul, Korea). Treatment consisted of 20 minutes of variant-mode electrical stimulation and 20 minutes of EMG biofeedback therapy per week administered by a specialized colorectal surgeon. All patients were evaluated by using a standardized questionnaire and a threshold for rectal sensation based on balloon distention before and after treatment.
RESULTS
At post EST-BF, six (67%) patients had experienced an improvement in symptoms, including five (56%) patients with complete symptom relief. Significant improvement in rectal sensation, especially the rectal defecation desire threshold (pre-EST-BF vs. post- EST-BF: 181.0+/-38.7 vs. 88.3+/-29.1) was achieved.
CONCLUSIONS
EST- BF may be an effective option for use in the treatment of functional constipation with impaired rectal sensation.

Early Experience with a Stapled TransAnal Rectal Resection for Obstructed Defecation Syndrome.: Shin, Jong Keun , Kwak, Chang Shin , Park, Jung Soo , Choi, Sung Il , Lee, Jae Bum , Park, Hyun Joo , Lee, So Jin , Lee, Doo Han , Kim, Do Sun; J Korean Soc Coloproctol. 2007;23(1):1-9.; DOI: https://doi.org/10.3393/jksc.2007.23.1.1

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Abstract PDF: PURPOSE
This study was designed to assess the early outcome of a stapled transanal rectal resection (STARR) in obstructed defecation syndrome (ODS) patients with rectocele and rectal intussusception.
METHODS
From January to December in 2005, 41 patients with the symptoms of obstructed defecation and the findings of rectocele and rectal intussusception in defecography, who failed in conservative management, were enrolled in this study. All patients underwent the STARR procedure. Preoperatively all patients received colonoscopy, a colon transit time test, cinedefecography, etc. The constipation score was evaluated by using the Cleveland Clinic Florida (CCF) constipation score preoperatively and at 1 month and 3 months after operation.
RESULTS
The mean age of the patients was 55.3 (19~76) years. There were three males and thirty-eight females. The mean operation time was 39.3 (25~80) minutes, and the mean hospital stay was 4.2 (4~6) days. Complications were fecal urgency in 9 cases (21.9%), which improved after 3 months, bleeding in 5 cases (12.2%), and anastomotic stenosis in 1 case (2.4%). At postoperative defecography, both intussusception and rectocele had disappeared in most patients. All constipation symptoms were significantly improved (P < 0.01). The mean CCF constipation score was 17.6 (11~24) preoperatively, and improved to 9.1 after 1 month and 8.2 after 3 months (P < 0.01). The overall patient satisfaction was graded as excellent, good, fairly good and poor in 19 cases (46.3%), 13 cases (31.7%), 4 cases (9.7%), and 5 cases (12.2%), respectively.
CONCLUSION
The STARR procedure seems to be a safe and effective procedure in ODS patients with rectocele and rectal intussusception. However, further study of the long-term results is required.

Outcome and Predictors of Biofeedback Therapy for Patients with Internal Rectal Intussusception.: Kwon, Soon Ho , Hwang, Yong Hee , Choi, Kun Pil; J Korean Soc Coloproctol. 2002;18(6):379-385.

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Abstract PDF: PURPOSE
The aim of this study was to determine the outcome and identify predictors of success of biofeedback therapy for patients with internal rectal intussusception.
METHODS
Twenty-one patients (median age. 54 years, 15 female, 6 male) diagnosed with internal rectal intussusception by using cinedefecography were evaluated by standardized questionnaire, before, immediately after treatment, and at follow-up. Clinical bowel symptoms and anorectal physiological studies were also analyzed.
RESULTS
Follow up (median: 15, range 2~24 months) results were evaluated by an independent observer in 20 patients. At post-biofeedback, 20 (95%) patients felt improvement in symptoms, including 7 (33%) with complete symptom relief. At follow-up, 17 (85%) patients felt improvement in symptoms, including 7 (35%) with complete symptom relief. There was a significant reduction in difficult defecation (from 90 to 29, 10 percent, from pre-biofeedback to post-biofeedback, and at follow up respectively; P<0.001), sensation of incomplete defecation (from 90 to 24, 35 percent; P<0.001), enema use (from 29 to 0, 0 percent; P<0.01), and anal pain (from 19 to 0, 0 percent; P<0.05). Digitation (from 19 to 0 percent, from pre- biofeedback to at follow up; P<0.05) and laxative use (from 29 to 5 percent; P<0.05) were also decreased. Normal spontaneous bowel movement was increased from 52 percent, at pre-biofeedback to 86 percent, at post- biofeedback (P<0.05), 95 percent at follow up (P<0.005). Low bowel frequency, at pre-biofeedback (P<0.01), and hard stool (P<0.05) predicted poor outcome. Long puborectalis length during push (P<0.05) and dynamic descent (P<0.05) on defecography also predicted poor outcome. Low electrical activities of puborectalis and anal sphincter muscle during rest (P<0.001), squeeze (P<0.01) and push (P<0.005) on pre-biofeedback electromyography were related to poor outcome. No patient developed full rectal prolapse during follow up.
CONCLUSIONS
Biofeedback is an effective option and should be considered as the first line therapy especially for patients that don't have low bowel frequency, long puborectalis during push, and dynamic descent before treatment.

Usefulness of Colonic Transit Time Measurement in Chronic Constipation.: Lee, Kun Young , Shim, Kang Sub , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 1998;14(3):569-576.

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Abstract PDF: A retrospective study of 274 patients who presented with constipation was done. The following results were obtained by recording colonic transit time. The male to female ratio was 72 : 197, and most patients were in their third and fifth decade, each age group accounting for 21% of total number. Associated symptoms were anal discomfort(33%), abdominal discomfort (25%), hematochezia (23%), reduced stool caliber (11%), and tenesmus (8%). As a result, 223 patients had normal transit time and 51 patients had abnormal transit time. Eighty-six patients with normal transit time and 51 patients with abnormal transit time underwent barium enema or colonoscopic examination. Abnormal lesions such as polyps and diverticulums were found in 10 patients with normal transit time and 7 patients with abnormal transit time. Therefore barium enema and colonoscopic examination in the patients with abnormal transit time were meaningful (P=0.024). Eighteen out of 25 patients with normal transit time and 8 (67%) of 12 patients with abnormal transit time showed abnormal defecogram results. The rectocele was the most frequent cause of abnormality in defecogram. Abnormal anal manometry results were obtained in 5 (22%) of 23 patients with normal transit time and 3 (50%) of 6 patients with abnormal transit time. Three types were classified in the patients with abnormal transit time. With type II patients, anal manometry findings were normal and 2 patients showed abnormal results in defecogram. With type III patients, 5 (43%) of 12 patients showed abnormal results in defecogram and 3 (50%) of 6 patients had abnormal anal manometry findings. Conclusively, if abnormal transit time is found in the patients with chronic consipation, further evaluations such as barium enema or colonoscopic examination are necessary. And even in the patients without any abnormality in transit time, selected performance of defecogram and anal manometry depending on clinical symptoms are preferable.

Case Report

A Case of Stercoral Perforation of the Sigmoid Colon.: Park, Chan Sup , Cho, Dong Ho , Kim, Hungdai , Han, Won Kon; J Korean Soc Coloproctol. 2006;22(3):197-199.

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Abstract PDF: A stercoral perforation of the colon is a rare phenomenon and is caused by severe prolonged constipation. Since the first reported case in 1894, approximately 80 additional cases have been reported. However, this rare condition seems to have been underestimated because of not only obscure diagnostic standards but also ignorance and failure to notice by surgeons. Due to its high mortality rate of about 35~40%, a stercoral ulcer perforation should be considered in any patient with chronic constipation who presents with peritonitis. We report a case of a 75-year-old female who was diagnosed as having a stercoral perforation of the sigmoid colon and review the clinical features, the diagnosis, and the treatment.

Original Articles

Anorectal Physiology in the Rectal Prolapse Patient.: Son, Kyung Soo , Joo, Jae Sik , Wexner, Steven D; J Korean Soc Coloproctol. 1998;14(3):467-476.

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Abstract PDF: PURPOSE
The aim of our study was to evaluate the physiological spectrum of anorectal dysfunction among patients with full thickness circunferential rectal prolapse. MATERIAL AND METHODS: Between January 1988 and March 1995, 88 patients who visited department colorectal surgery, Cleveland Clinic Florida with rectal prolapse were studied. There were 8 males and 80 females, with a mean age 69 (range 28~101) years. Patients underwent a detailed history and the following anorectal physiology tests were performed: anal canal manometry, pudendal nerve terminal motor latency (PNTML) assessment, anal electromyography and cinedefecography.4 standard continence scoring system, based on the frequency and type of incontinence (0=full continence, 20=complete incontinence) was used. Patients with rectal prolapse (n=88) were divided into two subgroups: Group I=continent patients (n=33) and Group II= incontinent patients (n=55).
RESULTS
There were statistically significant differences between each group when comparing mean resting pressures, anal pressures, anal canal length, rectal compliance, rectoanal inhibitory reflex, increased fiber density, the occurrence of premature evacuation (p<0.001), and rectal capacity (p<0.05). However, dynamic changes of anorectal angle, resting anorectal angle, puborectalis length, and rectal sensitivity were not significantly different (p>0.05) between groups.
CONCLUSION
Continence may be disturbed in patients with rectal prolapse; knowledge of impairment in continence may assist in surgical management.

Development and Clinical Application of the Biofeedback Anal Sphincter Control System for the Treatment of Patients with Functional Defecation Disorders Author Ung-Chae.: Park, Ung Chae , Kim, Jong Joo , Lee, Jong Kuk , Woo, Eung Je , Park, Seung Hun; J Korean Soc Coloproctol. 1998;14(3):459-466.

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Abstract PDF: Biofeedback is the treatment of choice for functional defecation disorders such as idiopathic chronic constipation and neurogenic fecal incontinence. The pre-existing biofeedback systems have many disadvantages. The aims of current project are, first, to develop the biofeedback system into the application software in the Windows environment, and, second, to assess the possibility of clinical usage for patients with functional defecation disorders. The hardware and software of the BASCO (Biofeedback Anal Sphincter Control) system were based on the signal measurement and signal processing of anal sphincter EMG (Electromyography). BASCO system was applied to 5 normal healthy controls and 20 patients with functional defecation disorders. Patients group was categorized as constipation group (N1=15) and incontinence group (N2=5). With use of current system, EMG-based biofeedback therapy was performed, and the outcome was analysed. Anal EMG signal data was processed by the software, and displayed in the monitor of personal computer. The software of EMG-display and database management were adequately operated. In N1 group, a paradoxical elevation or equalized activity of anal EMG pattern was shown in the simulated defecation. In N2 group, low electrical activity was shown. These findings were used for the EMG-based biofeedback therapy as a pilot study. The clinical symptoms were improved in 12 of N1 group and 3 of N2 group in the period of 3.7 (range, 1~12) months follow-up. In Conclusion, newly-developed BASCO system was adequately operated in the volunteer and patients groups. The multi-tasking and multi-processing functions were adequately shown in the real time. Current results could be used for clinical appraisal. Specifically, this system could be used for the practical application of biofeedback therapy in the patients with chronic constipation or fecal incontinence.

Psychiatric Investigation by Using the Minnesota Multiphasic Personality Inventory in Patients with Chronic Constipation.: Park, Ung Chae , Yoo, Young Bum , Kim, Jong Jun , Nam, Beom Woo; J Korean Soc Coloproctol. 2002;18(2):95-103.

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Abstract PDF: PURPOSE
Current study was designed to understand the personality and emotional composition of patients with chronic constipation. Specifically, the personality differences were evaluated in the ramified subgroups based on the physiologic characteristics.
METHODS
Forty patients (31 females and 9 males) of a mean age of 48 (range, 16~86) years underwent the MMPI among 310 patients with chronic constipation. MMPI (Minnesota Multiphasic Personality Inventory) profiles were utilized for psychologic assessment for all patients prior to making diagnosis. Three validity scales of MMPI included L (Lie scale), F (Infrequency scale), K (Suppressor scale). Ten clinical scales included HS (hypochondriasis), DP (depression), HY (hysteria), PD (psychopathic deviant), MF (masculinity- feminity), PA (paranoia), PT (psychasthenia), SC (schizophrenia), MA (mania), SI (social introversion). On the basis of findings with use of anorectal physiologic studies, subgroups were categorized as patients with rectocele (A1, n=22), patient without rectocele (A2, n=18), patients with nonrelaxing puborectalis syndrome (B1, n=10), patients without nonrelaxing puborectalis syndrome (B2, n=30). The MMPI profiles were compared between subgroup patients.
RESULTS
In overall patients, mean scores for scales HS, DP were elevated as compared with mean profiles (60~65 and 45~55, respectively). Male patients showed higher mean scores for scale SI than those of female patients (male vs. female; 63.5 vs. 53.9, P<0.05). A1 group showed higher mean scores for PD scale than those of A2 group (A1 vs. A2; 57.4 vs. 49.8, P=0.01). B1 group showed higher mean scores for DP scale than those of B2 group (B1 vs. B2; 67.5 vs. 59.8, P<0.05).
CONCLUSIONS
Present series provided that the MMPI is a valuable tool for assessing the psychologic functioning of patients with chronic constipation. It has revealed a different personality and emotional composition in the subgroup patients based on the anorectal physiologic studies. An aspect of social introversion, psychopathic deviant and depression should be emphasized. These findings can provide the fundamental information for guideline of future diagnostic evaluation and therapy in the patients with chronic constipation.

Risk Factors of Recurrent Hemorrhoid after Primary Management.: Yong, Sung Sang , Joo, Jae Sik , Son, Kyung Soo , Lee, Ho Suk , Choi, Byung Soo , Lee, Sung Kyu; J Korean Soc Coloproctol. 1998;14(2):275-282.

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Abstract PDF: Before surgery for hemorrhoid, patients always have a worry of postoperative recurrence. The exact incidence and risk factors of recurrent hemorrhoid have not yet been delineated up to now. Therefore, the aim of this study was to assess the etiology of the recurrence after surgery. MATERIAL AND METHODS: Between March, 1997 and Feburary 1998, all patients who visited the Dept. of Surgery, Korea Veteran Hosipital, due to the recurrent hemorroid after surgical managememt including sclerotherapy(Group II: GII, n=60) were compared to the age and sex mathed(1:2) with primary hemorroid patients(group I: GI, n=120). The risk factors which might be related with the recurrence such as 1) hemorroidal factor(duration of symtom, symtom, associated perinial disease) 2) patient factor (constipation, incontience, cardiovascular disease, pulmonary and hepatic disease) 3) anorectal physiologic factors 4) surgical factors were evaluated. Stastical analysis were performed by a chi-square-test or Mann-Whitney U test and set the significance at p<0.05.
RESULTS
There were no differences between the two groups in terms of age(GI 58.1+/-8.5, GII 60.9+/-3.3 years), gender(M:F, GI; 97:23, GII; 56:4 ). The ratio of having a contipation before surgery was 41% in GI, 55% in GII. It was not statistically significant. However, the other factors related with constipation such as duration of constipation(GI; 9.85+/-7.73 years, GII; 14.62+/-7.38 years: p<0.05), duration of straining during defecation(GI; 5.82+/-2.34, GII; 7.32+/-5.6 minutes, p<0.05) number of laxative use(GI; 29, GII; 28) were significantly different between the two groups. The fecal incontince are 5% in group Iand 13% in group II. There were no differences in patient's subject symtoms related with hemorrhoid, and comorbid perianal disease between the two groups. In anorectal manometric findings, rectal complince was significantly lower in GII than that of GI(25.1+/-50.04 cc/cmH20 vs 16.0+/-25.2 cc/cmH20 p<0.05). GII has a significant number of preopertive hypertension than GI(6.7% vs. 21.6%, p<0.05). CONCLUSION: When a patient with hemorrhoid has a constipation or hypertension, and lower compliance in manometric findings, it would be related with the postoperative recurrence after treatment. Therefore, we surgeons should correct these comorbid conditions before surgery, otherwise give an information to the patient of high chance of postoperative recurrence after management.

Clinical Significance of Amplitude in Pudendal Nerve Conduction Study in Patients with Defecation Disorders.: Joo, Jae Sik , Kim, Jae Do; J Korean Soc Coloproctol. 1998;14(2):241-246.

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Abstract PDF: Many different kinds of anorectal physiologic studies were performed for the evaluation of defecation disorders. Some of these studies are anorectal manometry and pudendal nerve conduction study. In pudendal nerve conduction study, pudendal nerve terminal motor latency (PNTML) was considered to be very useful for the evaluation and management of these patients. However, evaluation of amplitude in pudendal nerve conduction study has been clinically seldom used. Therefore, the aim of this study was to evaluate the clinical significane of amplitude in pudendal nerve conduction study in patients with defecation disorders by comparing to manometric profiles. MATERIAL AND METHODS: Between February, 1997 and February, 1998 all patients who underwent pudendal nerve conduction study and anorectal manometry for the evaluation of defecation disorders (constipation and fecalincontinence) were analyzed. Latency as well as amplitude in pudendal nerve conduction study were compared in both groups to the pressure profiles in manometric study according to the subgroups of these patients. Statistical analysis were performed by a Chi-square or Student's t-test and significance was assumed when p<0.05.
RESULTS
A total of 80 patients, forty constipation with a mean age of 55.3+/-14.5 (GI: range; 24~86) years and forty fecal incontinence with a mean age of 61.1+/-10.3 (GII: range; 37~74) years and a male to female ratio of 25:15 (GI), 28:12 (GII), were studied. PNTML in both sides in GI were significantly decreased in comparision to those of GII (GI: Rt, 2.17+/-0.7 ms Lt, 2.03+/-0.5 ms, GII: Rt, 2.50+/-0.7 ms, Lt 2.64+/-0.8 ms, p<0.05), However, there were no differences between the two groups in terms of amplitudes (GI: Rt 399.0+/-348 uV, Lt 426.8+/-403 uV, GII: Rt, 406.9+/-273 uV Lt, 392.9+/-291 uV, NS) in pudendal nerve conduction study. In manometric findings, even though maximal resting, mean, minimum and maximal pushing pressures were no differences in both groups, mean resting and maximal squeezing pressure were significantly increased in GI than those of GII (GI: 82.4+/-31 cmH20, GII: 60.5+/-25 cmH20 in mean resting pressure, GI: 213.1+/-108 cmH20, GII: 178.7+/-66 cmH20 in maximal squeezing pressure, p<0.05) When we analyzed the overall values of amplitudes according to the diagnosis, age, gender, and the value of PNTML, there were no statistically significant differences between the two groups. But, when the one side of PNTML shorter than the other side, it tended to have a high amplitude in that side than that of the other side in the same patient (the probability for trend was 74%).
CONCLUSION
Constipation patient has a shorter PNTML, higher mean resting, and maximal squeezing pressure than fecal incontinene patient. The amplitude in pudendal nerve conduction study had a trend of inverse correlation to the latency in the same patient. Therefore, amplitude in pudendal nerve conduction study might be useful to monitor or predict the outcome after treatment in patients with defecation disorders.

Review

Motility Disorders of the Colon.: Lee, Sang Jeon; J Korean Soc Coloproctol. 2005;21(5):337-353.

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Abstract PDF: Human colonic motor activity is quite a complex issue and is a relatively difficult topic to investigate, still only partly understood and investigated, due to anatomic and physiological difficulties. Colonic motility measurement are hampered by the relative inaccessibility of the colon, especially in the unprepared state. Major motor events are infrequent, necessitating long observation periods. Moreover, correlating intraluminal pressure changes with stool transport is difficult. Disturbances of normal colonic motor activity may interfere with healthy colonic physiologic function. The pathophysiological mechanisms responsible for colonic motility disorders are still less understood. In recent years, however, some more data have been obtained, even in proximal segments. These data have helped in elucidating, although only in part, some pathophysiological mechanisms of colonic motility disorders. In this review article, after a brief of relevant normal aspects of colorectal motility in man, we limit our discussion to more common motility disorders involving the colon and rectum. In particular, what is known or hypothesized regarding the underlying pathophysiology of slow-transit constipation, diverticular diseases, irritable bowel syndrome, and intestinal pseudo-obstruction is reviewed.

Original Articles

Perineal Rectosigmoidectomy with Levatoroplasty for Rectal Prolapse Early functional outcome.: Yoon, Seo Gue , Lee, Jong Ho , Yoon, Jong Seob , Kim, Kuhn Uk , Kim, Hyun Shig , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(5):220-226.

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Abstract PDF: PURPOSE
This study was designed to analyze the short-term clinical and functional outcomes of perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse.
METHODS
The data were prospectively collected and consisted of the clinical data, the functional status before and after surgery, the operation record, and the postoperative course. The functional status was evaluated by using Wexner's constipation score (0-30), Wexner's incontinence score (0-20), anorectal manometry, and pudendal nerve terminal motor latency. Follow-up was performed at 3-6 months after the operation by using both a standardized questionnaire completed in the outpatient clinic or telephone interview (n=23) and an anorectal physiology test (n=7).
RESULTS
During a one-year period, 23 patients (male=10) underwent perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. The median duration of the operations was 88 minutes. The median length of postoperative hospital stay was 6 days. There was one urinary tract infection and no mortalities. The constipation score was significantly decreased after the operation (9.8 vs 3.8; P<0.001), and constipation was improved in 90 percent (19/21) of the cases. The incontinence score was significantly decreased after surgery (mean preop.=11.6, postop.=3.7; P<0.001) and incontinence was improved in 17 of 21 patients with impaired continence (81 percent). Anal sphincter function was not improved but rectal reservoir capacity was significantly decreased after surgery (rectal urgent volume (45.7 cc vs 37.1 cc; P=0.045), maximal tolerable volume (120 cc vs 85.7; P=0.011). Most patients (83 percent) felt that the operation had improved their symptoms. The major reasons for dissatisfaction after surgery were frequent defecation, fecal soiling, persistent or aggravated fecal incontinence, and recurrence. One patient had a complete recurrence (4.3 percent), and another patient had a mucosal prolapse which was treated.
CONCLUSIONS
Perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse is a safe technique with acceptable short-term functional results; however, it is not recommended for rectal prolapse patients with diarrhea-predominant irritable bowel syndrome.

Biofeedback Therapy for Patients with Rectocele.: Kim, Bong Soo , Hwang, Yong Hee , Choi, Kun Pil; J Korean Soc Coloproctol. 2001;17(2):69-75.

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Abstract PDF: PURPOSE
The aim of this study was to determine the outcome and identify predictors of success of biofeedback therapy for rectocele.
METHODS
Twenty four female patients (mean age 43.8 years) with rectal emptying difficulties and a rectocele greater than 2 cm at defecography were evaluated before hand with a standardized questionnaires, immediately after biofeedback therapy, and at follow up. Defecography, manometry, colon transit studies and electrophysiology were also analyzed.
RESULTS
Follow up (mean 7.2; range 2~17 months) results were evaluated by an independent observer in 20 patients. At the end of biofeedback, 22 (92 percent) patients felt improvement in symptoms, including 13 (54 percent) with symptomatic relief. At follow-up, 14 (70 percent) patients felt improvement in symptoms, including 3 (15 percent) with complete relief of symptoms. There was a significant reduction in difficult defecation (from 79 to 29, 40 percent, from pre-biofeedback to post-biofeedback, at follow-up respectively; P<0.001, P<0.05), sensation of incomplete defecation (from 96 to 46, 60 percent; P<0.001, P<0.005), laxative use (from 54 to 25, 30 percent; P<0.05), enema use (from 21 to 0,0 percent; P<0.05), anal pain (from 21 to 0, 5 percent; P<0.05) and digitation (from 21 to 4, 5 percent). Normal spontaneous bowel movement was significantly increased from 50 percent pre-biofeedback to 83 post-biofeedback (P<0.05), 65 percent at follow-up. Abdominal pain (P<0.05) and digitation (P<0.05) related to poor results. High mean squeeze pressure (P<0.001) and high maximum squeeze pressure (P<0.05) on pre-biofeedback manometry were also related to a poor outcome. Age, duration of symptoms, parity, number of sessions of biofeedback, gynecologic surgery history, and rectocele size at defecography had no prognostic value. Anismus and colonic inertia did not influence the outcome of biofeedback.
CONCLUSIONS
Biofeedback is an effective treatment option for patients with obstructed defecation due to rectocele.

Clinical Results of Subtotal Colectomy in Chronic Constipation Patients.: Nam, Kee Hyun , Sohn, Seung Kook; J Korean Soc Coloproctol. 2000;16(6):395-401.

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Abstract PDF: PURPOSE
The aim of this study was to assess the outcome of subtotal colectomy on patients with a diagnosis of chronic constipation.
METHODS
A retrospective review of 11 consecutive patients who underwent subtotal colectomy between January 1990 and July 1999 was undertaken. Preoperative testings included complete history and physical examination, anorectal manometry, videodefecography, and colonic transit studies.
RESULTS
The 11 patients consisted of 5 men and 6 women, with a mean age of 44 (range, 25~62) years. The most common symptom was inability to defecation and mean duration of this symptom was 13.6 (range, 0.75~45) years. Ten patients had slow colon transit and one patient had normal colon transit with anismus. All patients were followed up for mean duration of 33 (range, 5~120) months. Mean bowel frequency was 4 times per day after colectomy. Nine patients were satisfied with the results of surgery and showed improvement in quality of life. One patient was less satisfied due to diarrhea even with several times bowel movement per day. One patient felt that the operation was not so effective due to incontinence for liquid stool and 7 bowel movement per day. Three patients frequently used antidiarrheal medication after surgery. Three patients had postoperative small bowel obstruction and were treated without surgery.
CONCLUSION
Subtotal colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients with proven slow transit constipation.

A Role of Anorectal Physiologic Study for the Diagnosis of Chronic Constipation.: Kim, Seung Han , Hwang, Yong Hee , Choi, Kun Phil; J Korean Soc Coloproctol. 2000;16(4):231-238.

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Abstract PDF: To assess the role of anorectal physiologic study for the diagnosis of chronic idiopathic constipation.
METHODS
A retrospective study of 81 constipated patients (23 male, 58 female) of mean age 48 16.6 (16~83) years who had no abnormalities in colonoscopy, barium enema, and rectal exam was done. 81 patients underwent defecography and cine-defecography, of which 66 patients underwent anal manometry, 52 patients underwent colonic transit time study (CTT), and 27 patients underwent anal plug electromyography (EMG).
RESULTS
Nonrelaxing puborectalis syndrome (NRPR), rectocele, rectal intussusception, anal dyschezia, and sigmoidocele were observed in 27 (33.3%), 26 (32.1%), 14 (17.3%), 3 (3.7%), and 2 (2.5%) of the patients, respectively. Normal cinedefecography finding was observed in 21 (25.9%) patients. More than one abnormal finding was found in 11 (13.6%) patients. Abnormal findings included colonic inertia in 6 (11.5%) patients and pelvic outlet obstruction in 2 (3.8%) patients. Normal colon transit time was observed in 44 (84.6%) patients. Anal hypertonia was observed in 23 (34.8%) patients by anal monometry, of which 3 patients were diagnosed with anal dyschezia in cinedefecography. 13 (48.1%) patients were diagnosed with NRPR in anal plug EMG. The correlation rate between cinedefecography/EMG, defecography/CTT, and CTT/EMG were 81.5%, 61.5%, and 51.9% respectively in the diagnosis of NRPR. Sensitivities of the three tests were 72.7% for cinedefecography, 66.7% for EMG, and 7.7% for CTT in diagnosing NRPR (p<0.05). Positive predictive values of the three tests were 80% for anal plug EMG, 72.7% for cinedefecography, and 50% for CTT in the diagnosis of NRPR.
CONCLUSIONS
Defecography and EMG were complements each of the other in diagnosis of pelvic outlet obstruction especially NRPR, but CTT has no role.

Clinical and Physiologic Characteristics of Rectal Prolapse in Males.: Yoon, Seo Gue , Lee, Kwang Real , Cho, Kyung A , Hwang, Do Yean , Kim, Khun Uk , Kang, Young Won , Park, Weon Kap , Kim, Hyun Sik , Lee, Jung Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2000;16(4):223-230.

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Abstract PDF: This study compares the sexual differences among rectal prolapse patients regarding the clinical and the physiologic characteristics with emphasis on males.
METHODS
The clinical data, functional status and operative records of 43 patients, who had completed both clinical and functional evaluations were collected in a prospective database and were analyzed according to sex. The functional status of the patients was evaluated by Wexner's constipation score (0~30), Wexner's incontinence score (0~20), anorectal manometry, and pudendal nerve terminal motor latency (PNTML).
RESULTS
The incidences of rectal prolapse in males (n=22) and in females (n=21) were similar. The age of onset for males was lower (mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and the duration of symptoms was longer (31.5+/-19.87 vs 12.5+/-14.31 years; p<0.001). Surgery in males was most commonly performed during the sexually active years (51.2+/-16.34 vs 64.5+/-13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17; p=0.065). The incidences and the severities of defecation difficulty in males and females were similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner score=4.3 vs n=17, mean Wexner score= 14.2; p<0.001). The maximum resting pressure was higher in males (39.2+/-21.46 vs 26.3+/-19.98 mmHg; p=0.049), and the maximum squeezing pressure was better preserved (131.2+/-62.63 vs 67.5+/-37.99 mmHg; p<0.001). No significant difference existed in the PNTML. Female patients underwent abdominal resection rectopexy (n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme's procedure (n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with lavatoroplasty (n=8), Delorme's procedure (n=14)) for fear of sexual dysfunction after the abdominal approach.
CONCLUSIONS
These findings suggest that the mechanism for developing rectal prolapse in male and female may be different and that surgical treatment should be tailored to the patient.

Clinical and Physiologic Study of Encopresis.: Chung, Soon Sup , Kwon, Jae Bong; J Korean Soc Coloproctol. 2000;16(3):171-176.

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Abstract PDF: The pathophysiology of pediatric encopresis has been incomprehensible. The current study was designed to assess its clinical and physiologic findings. Moreover, outcome of treatment was evaluated.
METHODS
The clinical and functional findings of 18 patients (13 boys, 5 girls) were analyzed, retrospectively. Physiologic studies for cooperative child included anal manometry (n=12), cinedefecography (n=3), and PNTML (pudendal nerve terminal motor latency, n=1). For exclusion of the organic cause, barium contrast study was carried out in all case. Patients were categorized by leading symptom as constipation or incontinence. Physiologic findings and outcome of treatment were analyzed based on the categorized groups. Biofeedback therapy by using newly-developed anal sphincter control system (KONTINENCE CLINICAL(TM)) in my institute, was underwent a mean 4.1 (range, 2~12) sessions. The outcome was analyzed in the period of 5.4 (range, 1~33) months follow-up.
RESULTS
Patients were categorized as having constipation (group I, n=12) or incontinence (group II, n=6) group. In the manometric parameters, there were no statistical differences between the values of the mean resting pressure (RP), the maximum RP, and the maximum voluntary contraction between group I and II. In the cinedefecography, 3 of group I patients revealed as having the pelvic floor dyssynergia. The findings of PNTML were not specific in group II (n=1). Regarding to the therapeutic outcome, 8 of 10 patients were cured or improved.
CONCLUSIONS
There were no differences in the resting and squeeze profiles of manometric parameters between two groups. However, pelvic floor dyssynergia was identified in the cinedefecography of constipated group. Conventional and biofeedback treatment for encopretic children provides acceptable outcome.

Clinical Analysis of Total Colectomy for Chronic Idiopathic Constipation.: Lim, Sae Woung , Oh, So Hyang , Lee, Woo Yong; J Korean Soc Coloproctol. 2000;16(3):150-155.

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Abstract PDF: The aim of this study was to analyse clinical feature and outcome of patients following total abdominal colectomy and ileorectal anastomosis.
METHODS
All of 8 patients subjected to surgery during 5 year period from May 1995 to December 1999 were reviewed using retrospective method.
RESULTS
All patients had slow colonic transit and 7 patients (male to female, 1:1.6) with a mean age of 54 (range, 27~70) years underwent total abdominal colectomy and ileorectal anastomosis and one patient had right hemicolectomy. Major symptoms were abdominal pain and bloating and mean bowel action was 18.5 days, mean suffered time before operation was 26.3 years. Colonic transit study, defecography and rectal manometry were done in all cases. Pelvic floor dysfunction was combined in 5 patients. Median follow up was 2.7 years. There was one mortality case due to postoperative pneumonia and ARDS in a 70 year old patient. Except one mortality case, there was significant success rate, overall 71%.
CONCLUSIONS
Colectomy with ileorectal anastomosis produces a satisfactory outcome in the majority of patients undergoing surgery for chronic idiopathic constipation.

Development of Second Stage Software in the Anal Sphincter Control System Based on the Anal Electromyography, and Investigation of Therapeutic Outcome of the Patients withChronic.: Park, Ing Chae , Seong, Moo Kyung , Chung, Soon Sup , Kim, Jong Jun , Park, Seung Hun; J Korean Soc Coloproctol. 1999;15(4):281-290.

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Abstract PDF: To eliminate the inconvenient shortcomings of our formerly designed system for the biofeedback treatment, the development of second stage software was indispensable. PURPOSE: The aims of current study were to supplement the prototype software, and to improve the application software for the database management system. Moreover, we assessed the practical value and outcome of biofeedback therapy for the patients with functional evacuation disorders by using the upgraded system.
METHODS
A new system was worked out a design to be composed of Windows based GUI (graphical user interface), DB (database) management software, and networking system. Main software performs a signal processing and a protocol making mode to train pelvic sphincter. DB program administers patient profiles and the recorded signal data. Networking system was designed to execute RS-232C serial communication of signal data with use of fast ethernet LAN networking. To affirm the reproducibility of signal display for the clinical practice, system was applied to 5 healthy volunteers. To evaluate the practical appraisal, system was applied to 27 patients with functional evacuation disorders who were undertaken anorectal physiologic tests. Patient groups were categorized as nonrelaxing puborectalis group (group I, n=17), incontinencegroup (group II, n=10). Overall patients were underwent a mean 3.7 (range, 2~10) sessions of biofeedback treatment, and the outcome was analysed in the period of 5.8 (range, 3~12) months follow-up.
RESULTS
Signal data not having drift or noise were adequately processed and displayed in a real time. Specifically, data upload with use of multi-processing overay display function was appropriately embodied. Overall data and profiles of patients groups were safely saved, sorted, and reproduced by using the upgrading database management software. Regarding to the therapeutic outcomes, 63 percent of 27 overall patients (12 of 17 patients in group I, 5 of 10 patients in group II) were improved. The subjective symptoms of 2 patients in group I were recurred in a period of 3 months follow-up.
CONCLUSIONS
Hardware and software functions of upgraded system were applicable to the Windows environment of personal computer. A developed system with second stage software made it possible to perform biofeedback treatment. Specifically, current results could be useful for the improvement of the motivation and patient's willingness in the self-learning process of biofeedback treatment.

The Effectiveness of Biofeedback Therapy for Children Patients with Chronic Constipation.: Jung, Sang Ho , Kim, Jong Tae , Cho, Hyun Un , Go, Hong Jun , Jung, Gwang Gun , Park, Soon Tae , Ha, Woo Song , Hong, Soon Chan , Lee, Young Joon , Lee, Byung Ju , Choi, Sang Kyung; J Korean Soc Coloproctol. 2003;19(3):137-143.

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Abstract PDF: PURPOSE
Chronic constipation is not uncommon even in children. Recently biofeedback treatment (BT) is considered as a useful modality in the treatment of various types of constipation. The aim of this study was to evaulate the effectiveness of BT in children with chronic constipation.
METHODS
We reviewed 24 cases of childhood constipation (17 boys, 7 girls) who visited the Jinju Hakmoon colorectal surgery clinic and GNUH1 between April, 2001 and September, 2002. Balloon-mediated anorectal manometry system was used for BT. The effects of therapy was assessed by bowel movement, defecation time, fecal soiling and balloon evacuation test in the early course of therapy. The long term follow up survey was done by telephone interview at January 2003 and the effects of therapy was assessed by bowel movement, defecation time, fecal soiling and parents' satisfaction.
RESULTS
Patients received the BT for the three times on average, and as the result of the therapy, 20 patients experienced disappearance of symptoms (87%) or at least improvement of symptoms. In terms of manometric values, the mean resting pressure was 113.4 mmHg before the BT, but decreased to 86.3 mmHg after the BT (P=0.0012). Mean pushing pressure dropped to 85.98 mmHg from 130.45 mmHg (P=<0.0001). Mean sensitivity decreased from 55 ml to 35 ml (P=0.0053). Mean compliance decreased from 20.28 H2O/cm to 4.21 H2O/cm (P=0.0015). 13 patients (76%) showed disappearance or improvement of symptoms in the long term follow up.
CONCLUSIONS
The Balloon mediated biofeedback therapy is effective in children with chronic constipation. It is safe, easy to administer and also improve symptoms and objective parameters of anorectal function. Balloon mediated biofeedback therapy could be the first-line therapy in child patient with chronic constipation who failed conservative management.

Clinical Significance of Defecography in Patients with Constipation.: Kwon, Ho Young , Kim, Kwang Ho , Shim, Kang Sub; J Korean Soc Coloproctol. 1999;15(3):195-202.

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Abstract PDF: PURPOSE
To evaluate the clinical usefulness of defecogrophy in diagnosing the etiology and pathophysiology of constipation. A retrospective study of 56 constipated patients who had no abnormalities in colonoscopy, barium enema and rectal exam were done.
METHODS
Fifty-six patients (12 men, 44 women) with constipation underwent defecography and 37 of the patients underwent colonic transit studies. Fluoroscopically guided defecography was performed with barium paste introduced into the rectum.
RESULTS
Normal defecography finding was observed in thirteen of the 56 patients. Rectocele, spastic levator syndrome (nonrelaxing puborectalis syndrome), sigmoidocele, rectal prolapse, rectal intussusception were observed in 67% (38/56), 30% (20/56), 7% (4/56), 5% (3/56) and 2% (1/56) of the patients, respectively. More than one pathological finding was found in 23 (53%) patients. Of the 38 rectoceles, 17 cases were found to be associated with spastic levator syndrome. In solitary rectocele, the anorectal angles at rest, during straining were 92.65 9.08o, 108.09 14.35o, while 99.85 11.85o, 95.90 17.84o, in spastic levator syndrome. In 36 difficult bowel movements, 66% (24/36), 30% (11/36), 3% (1/36) were found to have rectocele, spastic levator syndrome, and sigmoidocele, respectively. Normal colonic transit time was observed in twenty six of the 37 patients. Abnormal findings included colonic inertia in 3 (8%) patients, hindgut dysfunction in 4 (11%) patients, and, outlet obstruction in 4 (11%) patients. Of the normal colonic transit time in 26, rectocele in sixteen, rectal prolapse in 1, spastic levator in 2 were observed. Rectoceles were observed in 2 out of 3 colonic inertia, in all 4 hindgut dysfunction, in 1 out of 4 outlet obstruction.
CONCLUSIONS
Our findings suggest that constipation is often a disorder of defecation rather than a impairment of colonic motility. Defecography should be considered first of all in evaluating the pathophysiology of constipation, especially for whom complaining of difficult bowel.

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