Management strategies for obstructed defaecation

To see our latest courses, or to donate to the St Mark's Hospital Foundation, please visit our channel description for details. Title: Management strategies for obstructed defaecation Speakers: Arun Gupta, Gregory Thomas Event: Frontiers in Colorectal and Intestinal Disease 2024 Year: 2024 The presentation compares the advantages and limitations of MRI proctography and barium proctography in evaluating obstructed defecation, particularly when assessing functional disorders and structural abnormalities such as rectal intussusception or prolapse. The speaker explains that barium studies allow upright evacuation, offer higher frame rates, and often provide a more physiologic assessment of emptying, though they involve radiation and reduced soft‑tissue detail. MRI avoids radiation and provides a comprehensive multicompartment pelvic floor evaluation, including bladder and urethral behaviour, but is usually performed supine, uses gel rather than stool‑like paste, and captures only a narrow midline slice at one frame per second, which may miss rapid or lateral pathology. Patient experience differs between techniques, with MRI offering greater privacy but often making evacuation more difficult due to claustrophobia and positioning. Clinical examples highlight how MRI may suggest anismus when the patient cannot empty, whereas barium studies may show effective evacuation. The second half of the talk reviews management of rectal intussusception, rectocele, and anismus, emphasising that these conditions are common, often multifactorial, and frequently require conservative therapy such as biofeedback before surgery is considered. Surgical decisions depend on symptom severity, associated defects, and multidisciplinary assessment.