Defäkationsstörungen

Defecation disorders (obstructive defecation syndrome, ODS) and stool incontinence occur frequently and cause significant socioeconomic burden. Stool incontinence may develop following failure of single or multiple continence functions (sphincter function, rectal compliance, sensory function, stool consistency). This may be caused by inflammatory, proliferative or postsurgical diseases or descending pelvic floor. Defecation disorders may be associated with chronic constipation or irritable bowel syndrome. Stool incontinence should be evaluated by validated scores. Diagnosis includes the patient history, rectal–digital examination and individual differentiated evaluation of anorectal function (anorectal manometry, defecography, balloon expulsion test, electromyography, barostat investigation). Therapy comprises pelvic floor–biofeedback–toilet training, fiber, macrogol, laxatives, enemas and suppositories. Surgical therapy includes the stapled transanal rectal resection (STARR) procedure, pelvic floor plastic surgery, sacral nerve stimulation, and creation of a stoma.