Improvement in functional and mental outcomes after resection rectopexy for obstructive defecation syndrome ODS.

Abstract

Obstructive defecation syndrome (ODS) is a condition that causes straining and may require manual evacuation and patients' thoughts circle around defecation impairing their quality of life. Mental comorbidity-related findings suggest a mental burden in ODS patients. In an observational cohort design, this study investigated the relationship between the mental distress and their clinical symptom severity for a group of patients with ODS who underwent surgical treatment. This study included 108 consecutive patients with ODS who were scheduled for laparoscopic resection rectopexy combined with pelvic floor repair, if indicated. Clinical symptom severity (Altomare score, rectal toxicity score, and Wexner incontinence score) and mental health scores (Generalized Anxiety Disorder-7 [GAD-7] and Personal Health Questionnaire-9 [PHQ-9]) were assessed before and 6 months after surgery. Before surgery, 82.5% of patients had at least mild depressive symptoms (PHQ-9 score ≥ 5), and 55.6% of patients had at least mild anxiety (GAD-7 score ≥ 5). The severity of the mental health scores correlated with the clinical symptom severity. At the 6-month follow-up, the bowel function scores improved significantly. Depression symptoms improved, whereas only slight changes in anxiety symptoms were observed. The improvement in clinical symptom severity correlated with better mental score results, whereas the severity of the preoperative mental distress did not influence the surgical or follow-up outcomes. Patients with obstructive defecation syndrome (ODS) experience significant depression and anxiety that adversely affect their quality of life. Surgical improvement of bowel function reduces depressive symptoms and, to a lesser extent, anxiety symptoms. Early multidisciplinary intervention should be considered for effective management. Future studies should further investigate mental distress caused by ODS symptoms or other underlying psychiatric comorbidities.