Outcome of colectomy for combined colonic inertia and pelvic floor dysfunction

Optimal treatment for severe constipation caused by combined colonic inertia (CI) and pelvic floor dysfunction (PFD) is controversial. This study evaluated the outcome of total colectomy alone for patients with combined colonic inertia and pelvic floor dysfunction. From 1994 to 1998, fourteen patients who had a combination of colonic inertia and pelvic floor dysfunction as diagnosed by transit marker study, anorectal manometry, and defecography were enrolled in the study. Total colectomy with ileorectostomy alone was performed in all patients. Postoperatively, stool frequency significantly increased from 1.8 + 0.7 times per week to 21 + 9.6 times per week (p=0.022). The incidence of abdominal pain significantly decreased to 21.4% (p=0.027) and the incidence of abdominal bloating significantly decreased from 71% to 21% (p=0.011). Difficult evacuation was not noted in these patients. Four patients (28%) experienced small bowel obstruction and one patient required laparotomy for division of adhesions. Treatment satisfaction was achieved in 85.7% of the patients. The results of this study demonstrate that total colectomy alone can improve the abdominal symptoms in severely constipated patients when the presenting symptoms are combined colonic inertia and pelvic floor dysfunction. Pelvic floor dysfunction is not a contraindication for colectomy in patients with combined CI and PFD.