[vc_row row_type=”0″ row_id=”” blox_height=”” video_fullscreen=”true” blox_image=”” blox_bg_attachment=”false” blox_cover=”true” blox_repeat=”no-repeat” align_center=”” page_title=”” blox_padding_top=”” blox_padding_bottom=”” blox_dark=”false” blox_class=”” blox_bgcolor=”” parallax_speed=”6″ process_count=”3″ video_url=”” video_type=”video/youtube” video_pattern=”true” row_pattern=”” row_color=”” maxslider_image1=”” maxslider_image2=”” maxslider_image3=”” maxslider_image4=”” maxslider_image5=”” maxslider_parallax=”true” maxslider_pattern=”true”][vc_column width=”1/1″][vc_single_image image=”690″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self” img_size=”full”][vc_column_text]CONSTIPATION-PROLAPSE RECTAL AND PROLAPSE UROGENITAL
Constipation is a very common disorder and one of the most common reasons a patient goes to the doctor. If There are two types: primary or idiopathic and secondary. Idiopathic constipation is manifested in two forms: by colonic and terminal inertia. The secondary constipation is due to systemic causes (drugs, metabolic abnormalities, endocrine abnormalities) and / or of gastrointestinal origin. Idiopathic constipation colic inertia, characterized by lengthening of the colonic transit time, is typical of those patients who defecate less than three times a week and do not feel any need to go to the bathroom. The terminal idiopathic constipation is typical of those patients who feel the urge to defecate but fail to defecate if not and / or only with great difficulty due to the presence of an obstacle to the expulsion of the fecal bolus or for the inability to perform properly the ‘expulsion. The alterations that most often determine an obstacle fecal expulsion are the mucosal prolapse of the rectum and rectal intussusception until complete rectal prolapse, rectocele (herniation of the anterior rectal wall into the vagina) and enterocele (herniation of loops of small intestine between the rectum and vagina). These alterations form a true “plug” making it difficult fecal expulsion resulting in symptoms such as: fractional evacuation in several times during the day with many unsuccessful attempts and prolonged efforts, sensation of incomplete evacuation due to incomplete emptying of the rectum, need to use enemas or manually help with a sense of perineal weight. There are also situations in which more ‘than an obstacle fecal expulsion the cause of constipation is the inability to eject the fecal bolus, or an inability and use an alteration of the pelvic floor muscles as in dell’ipertonia syndrome the puborectalis muscle, in default of rectal distension capacity such alterations can not be resolved surgically. The treatment of constipation should be as far as possible etiological so it is crucial to identify their causes.
To locate the cause of constipation should run some diagnostic tests for the study of the colon (Rx matte Clisma, colonoscopy, the study of intestinal transit time) pelvic anatomy (genitalia, bladder and rectum) and anorectal function (anorectal manometry , transanal ultrasound 3 D). Performed a thorough diagnostic study will decide to treat more ‘appropriate that can’ be dietary and behavioral (diet rich in water and fiber, integration with soluble fiber), pharmacological (laxatives) rehabilitation (pelvic physical therapy, biofeedback and electrical stimulation) or surgery.
The medical and / or surgical treatment of secondary forms is directly related to the underlying disease responsible. In cases where there is a failure of the various conservative treatments we proceed to the surgical treatment of diseases responsible ODS (Syndrome From Blocked defecation).
TREATMENT OF RECTAL PROLAPSE
In those patients with rectal mucosal prolapse, symptomatic rectocele, rectal intussusception, the prolapsed rectum resection is a rational and effective surgical treatment (adjusted rectal resection with stapler STARR or in case of a complete rectal prolapse Rettopessi sec. Delorme).
resection of the rectum via regulated Transanal S.T.A.R.R. with single or double stapler: It consists in the resection of the distal rectum via transanal employing the use of one or two circular mechanical staplers which remove a portion of the distal rectum full thickness suture and simultaneously by means of small titanium points. These points will be partially or completely ejected in the months following the defecation. This method consists of an adjustable resection depending on the amount of prolapsed tissue and the severity of symptoms of obstructed defecation and has the advantage of limiting the very post-operative pain allowing a quick recovery. The ultimate indication is given when the operative visit to spinal anesthesia, performing resection using a stapler only if the intrarectal prolapse reaches and / or exceeds half of the Port, performing resection with double stapling if the prolapse exceeds outer margin of the Port.
rettopessi sec. DELORME It is performing for the complete rectal prolapse therapy. It consists of a mucosectomia prolapsed rectum with plication of the muscle layer which contains the rectum in its natural position. You run around because Transanal.
Ventral Rectal Repair in case of rectal prolapse associated with an enterocele (herniation of bowel loops between the rectum and vagina) you need another type of surgical approach, which is performed via laparoscopy for abdominal: this action is intended to reduce the herniation of bowel loops between the rectum and the vagina to suspend prolapsed rectum and to obliterate the rectovaginal space. It uses a network of synthetic or biological material that is anchored to the anterior wall of the rectum, which is then suspended and anchored to the sacred.
TREATMENT OF PROLAPSE UROGENITAL
Italian five million suffer from urogenital prolapse that consists in blistering descent, vagina and rectum and is manifested by vaginal-pelvic dimensions, sense of perineal weight, constipation obstructed by expulsion with incomplete emptying Ampullaris and fractional evacuation, recurrent urinary infections and urinary incontinence .
The causes of this prolapse are varied: births and pregnancies, anorexia and bulimia, a sedentary view, chronic constipation and prolonged. The therapy also in this case must be etiological namely remove the alteration that causes these disorders. The instrumental study and preoperative functional must always include the shot-cistus-defecography, radiological-essential dynamic scanning for displaying all the pelvic organs (bladder-utero-rectal-colon-small intestine) at rest and in defecatory phase.
POPS (Pelvic Organ Prolapse Suspension) o SIR (Soft Intraperitoneal Recto-suspension): This technique provides for the suspension of the pelvic organs (vegina-bladder and rectum), which are fixed by means of a mesh of biocompatible synthetic fabric fastened with small points to the lateral muscles of the abdomen. The surgery is performed laparoscopically for abdominal way, ie by means of small holes which are placed on the abdomen of the operational tools. In this way the prolapsed organs are relieved and reported in the correct position by solving the symptoms due to their prolapse.[/vc_column_text][vc_column_text]ESAMI DIAGNOSTICI
Alla raccolta accurata delle notizie cliniche (frequenza delle defecazioni, caratteristiche delle feci, modalità e i disturbi durante l’evacuazione) seguono l’esame obiettivo generale e proctologico completo. Tra gli esami strumentali la rettosigmoidoscopia, Rx Clisma Opaco, defecografia, Rx Addome diretto, tempo di transito con marcanti radiopachi, manometria ano-rettale.
La terapia della stipsi deve essere per quanto possibile etiologico per cui è fondamentale individuarne le cause. Nella stipsi idiopatica da inerzia colica è doveroso raggiungere un regime dietetico ricco di scorie ed acqua, rieducando l’intestino e regolando la defecazione. Nella stipsi idiopatica terminale la terapia attualmente più efficace e meno invasiva è quella della terapia medica associata alla riabilitazione del pavimento pelvico attraverso il biofeedback e l’elettrostimolazione.Il trattamento medico e/o chirurgico delle forme secondarie è direttamente correlato alla patologia di base responsabile.[/vc_column_text][/vc_column][/vc_row]