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The Pelvic Floor in Gastrointestinal Practice

R owan Collinson, MBC hB, FRACS FRACS1, and Ian Lindsey, MBC hB, FRACS FRACS2

Treatment

Treatment of outlet obstruction is, to a certain extent, tailored to the cause, but all patients should optimize conservative measures initially, i.e. fiber supplementation and dietary advice. If this is unsuccessful, unless there is a very gross anatomical abnormality (e.g. rectoanal intussusception), biofeedback is indicated [39]. Several recent, randomized, controlled trials have confirmed the superiority of biofeedback over drug therapy, laxative therapy, placebo drugs, and sham-biofeedback therapy [40–42]. Regimens vary widely, but usually involve five to six once-weekly sessions to maximize the chance of improvement. If the patient remains symptomatic following this, surgical options may need to be explored.

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