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  1. Article ; Online: Sampling reflex: pathogenic role in functional defecation disorder.

    Pucciani, F / Trafeli, M

    Techniques in coloproctology

    2021  Volume 25, Issue 5, Page(s) 521–530

    Abstract: Background: The sampling reflex is necessary to begin defecation or flatulence. It consists of a simultaneous rectoanal inhibitory reflex (RAIR) mediated by relaxation of the internal anal sphincter and rectoanal excitatory reflex (RAER) mediated by ... ...

    Abstract Background: The sampling reflex is necessary to begin defecation or flatulence. It consists of a simultaneous rectoanal inhibitory reflex (RAIR) mediated by relaxation of the internal anal sphincter and rectoanal excitatory reflex (RAER) mediated by contraction of the external anal sphincter. The aim of this study was to evaluate the sampling reflex in patients with functional defecation disorder (FDD).
    Methods: A prospective cohort study was conducted on 58 obstructed defecation syndrome (ODS) patients with FDD. All 58 patients and 20 controls were evaluated with anorectal manometry to study the sampling reflex. Quantitative RAIR (total duration of reflex; maximal amplitude of relaxation; residual pressure at the lowest point of the RAIR) and RAER data (maximal amplitude of contraction; duration) were obtained. The straining test on manometry was considered positive for FDD if there was a muscle contraction/lack of relaxation or an insufficient pressure gradient for the passage of feces. Defecography was performed on all the patients with assessment of the anorectal angle and persistence or increase of puborectalis indentation.
    Results: Fifty (86.2%) FDD patients had an altered sampling reflex, showing incomplete/short duration of RAIR and excessive contraction/duration of RAER. More specifically, there was a correlation between a positive straining test and a short total duration of RAIR (ρ 0.92) as well as with excessive duration of RAER (ρ 0.89). There was also a correlation between lack of muscle relaxation on defecography and short total duration of RAIR ((ρ 0.79) and between lack of muscle relaxation on defecography and excessive duration of RAER (ρ 0.83). Altered maximal amplitude relaxation had the highest sensitivity in detecting impairment of RAIR (87.9) while maximal amplitude contraction had the highest sensitivity in detecting impairment of RAER (89.6). High residual pressure at the lowest point of RAIR had the highest specificity in detecting impairment of RAIR (80.0) while RAER duration had the highest specificity in detecting impairment of RAER (77.7).
    Conclusion: The sampling reflex is impaired in patients with FDD. This finding provides an important insight into the pathogenesis of obstructed functional defecation.
    MeSH term(s) Anal Canal ; Constipation/etiology ; Defecation ; Humans ; Manometry ; Prospective Studies ; Rectum ; Reflex
    Language English
    Publishing date 2021-02-15
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-020-02393-5
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  2. Article ; Online: A theory of progression from obstructed defecation to fecal incontinence.

    Pucciani, F

    Techniques in coloproctology

    2015  Volume 19, Issue 12, Page(s) 713–715

    MeSH term(s) Anus Diseases/physiopathology ; Constipation/complications ; Constipation/physiopathology ; Disease Progression ; Fecal Incontinence/etiology ; Female ; Humans ; Pelvic Floor Disorders/physiopathology ; Perineum ; Sensation Disorders/physiopathology ; Syndrome
    Language English
    Publishing date 2015-12
    Publishing country Italy
    Document type Editorial
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-015-1394-2
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  3. Article ; Online: Descending perineum syndrome: new perspectives.

    Pucciani, F

    Techniques in coloproctology

    2015  Volume 19, Issue 8, Page(s) 443–448

    Abstract: The classical clinical profile of descending perineum syndrome (DPS) has been replaced by new pathophysiological, diagnostic, and therapeutic acquisitions. This paper will focus on trigger factors ranging from dyssynergic defecation to excessive ... ...

    Abstract The classical clinical profile of descending perineum syndrome (DPS) has been replaced by new pathophysiological, diagnostic, and therapeutic acquisitions. This paper will focus on trigger factors ranging from dyssynergic defecation to excessive straining, fecal incontinence against the backdrop of obstructed defecation, attendant rectal diseases, and therapy tailored to evolving stages of DPS.
    MeSH term(s) Ataxia/physiopathology ; Defecation/physiology ; Fecal Incontinence/etiology ; Fecal Incontinence/therapy ; Humans ; Pelvic Floor ; Pelvic Floor Disorders/diagnosis ; Pelvic Floor Disorders/physiopathology ; Pelvic Floor Disorders/therapy ; Perineum/physiopathology
    Language English
    Publishing date 2015-08
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-015-1321-6
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  4. Article ; Online: Faecal soiling: pathophysiology of postdefaecatory incontinence.

    Pucciani, F

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2013  Volume 15, Issue 8, Page(s) 987–992

    Abstract: Aim: Passive postdefaecatory incontinence is poorly understood and yet is an important clinical problem. The aim of this study was to characterize the pathophysiology of postdefaecatory incontinence in patients affected by faecal soiling.: Method: ... ...

    Abstract Aim: Passive postdefaecatory incontinence is poorly understood and yet is an important clinical problem. The aim of this study was to characterize the pathophysiology of postdefaecatory incontinence in patients affected by faecal soiling.
    Method: Seventy-two patients (30 women, age range 49-79 years; 42 men, age range, 53-75 years) affected by faecal passive incontinence with faecal soiling were included in the study. Two patient groups were identified: Group 1 comprised 42 patients with postdefaecatory incontinence and Group 2 had 30 patients without incontinence after bowel movements. After a preliminary clinical evaluation, including the Faecal Incontinence Severity Index (FISI) score and the obstructed defaecation syndrome (ODS) score, all patients of Groups 1 and 2 were studied by means of endoanal ultrasound and anorectal manometry. The results were compared with those from 20 healthy control subjects.
    Results: A significantly higher ODS score was found in Group 1 (P < 0.001). Endoanal ultrasound revealed a significantly diffuse thinning of the internal anal sphincter (IAS) in Group 2 (P < 0.02) with a linear relationship between signs of IAS atrophy and the FISI score (ρs 0.78; P < 0.03). Anal resting pressure (Pmax and Pm ) was significantly lower in Group 2 (P < 0.04). The straining test was considered positive in 30 (71.4%) patients in Group 1, significantly greater than in Group 2 (P < 0.01). A significantly higher conscious rectal sensitivity threshold (CRST) was found in Group 1 patients (P < 0.01).
    Conclusion: The ODS score, a positive straining test and high CRST values suggest that postdefaecatory incontinence is secondary to impaired defaecation.
    MeSH term(s) Aged ; Anal Canal/physiopathology ; Case-Control Studies ; Cohort Studies ; Defecation/physiology ; Fecal Incontinence/diagnostic imaging ; Fecal Incontinence/physiopathology ; Female ; Humans ; Male ; Manometry ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Ultrasonography
    Language English
    Publishing date 2013-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.12236
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  5. Article ; Online: Post-surgical fecal incontinence.

    Pucciani, Filippo

    Updates in surgery

    2017  Volume 70, Issue 4, Page(s) 477–484

    Abstract: The primary endpoint of this work was to understand the pathophysiology of fecal incontinence manifested after rectal and anal surgery. A retrospective cohort study with negative colonoscopy patients was created and 169 postoperative incontinent patients ...

    Abstract The primary endpoint of this work was to understand the pathophysiology of fecal incontinence manifested after rectal and anal surgery. A retrospective cohort study with negative colonoscopy patients was created and 169 postoperative incontinent patients were analyzed (114 women and 55 men: mean age 58.9 ± 6.3): clinical evaluation, endoanal ultrasound and anorectal manometry reports were scanned. The duration of incontinence was very long, with a mean of 21.7 months. The mean number of bowel movements/week was 18.2 ± 7.2. Urge incontinence was present in 82.2% of patients, mixed with passive incontinence in 44 patients. Patients' Fecal Incontinence Severity Index (FISI) score was 27.0 ± 6.6. Operated patients had significantly lower anal resting pressure (P < 0.01) than controls while patients with colo-anal anastomosis and those who underwent Delorme operation had lowest values (P < 0.01). Maximal tolerated volume and rectal compliance were significantly impaired in operated patients with rectum involvement (colo-anal anastomosis, Delorme, restorative procto-colectomy and STARR). External anal sphincter (EAS) defects were present in 33.1% of all patients and internal anal sphincter (IAS) was damaged in 44.3%: a combined lesion of anal sphincters was detected in 39 patients (23.0%). A positive correlation was found between patients' FISI score and thickness of both sphincters (EAS: ρ
    MeSH term(s) Aged ; Anal Canal/diagnostic imaging ; Anal Canal/physiopathology ; Anal Canal/surgery ; Colon/physiopathology ; Colon/surgery ; Digestive System Surgical Procedures/adverse effects ; Endosonography ; Fecal Incontinence/diagnostic imaging ; Fecal Incontinence/physiopathology ; Fecal Incontinence/prevention & control ; Female ; Humans ; Hysterectomy/adverse effects ; Male ; Manometry ; Middle Aged ; Muscle Contraction ; Pelvic Floor/physiopathology ; Pelvic Floor/surgery ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/physiopathology ; Postoperative Complications/prevention & control ; Pressure ; Rectum/diagnostic imaging ; Rectum/physiopathology ; Rectum/surgery ; Retrospective Studies ; Severity of Illness Index ; Time Factors
    Language English
    Publishing date 2017-12-30
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-017-0508-y
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  6. Article: A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome.

    Pucciani, Filippo

    Updates in surgery

    2013  Volume 65, Issue 4, Page(s) 257–263

    Abstract: The aim of this review is to characterize the functional results and "anterior resection syndrome" (ARS) after sphincter-saving surgery for rectal cancer. The purpose of sphincter-saving operations is to save the anal sphincters by avoiding the need for ... ...

    Abstract The aim of this review is to characterize the functional results and "anterior resection syndrome" (ARS) after sphincter-saving surgery for rectal cancer. The purpose of sphincter-saving operations is to save the anal sphincters by avoiding the need for rectal abdomino-perineal resection with a permanent stoma. A variety of alternative techniques have been proposed and, today, ultra-low anterior resections of the rectum are commonplace. Inevitably rectal resections modify anorectal physiology. The backdrop of the functional asset for ultralow anterior resections is related to a small neorectal capacity with high endo-neorectal pressures that act together on a weakened sphincteric mechanism. Sometimes a defecation disorder called ARS may be induced and the patient experiences an extremely low quality of life. Impaired bowel function is usually provoked either by colonic dysmotility, neorectal reservoir dysfunction, anal sphincter damage or by a combination of these factors. Surgical technique defects can contribute to these possible causes: anastomotic ischemia, short length of the descending colon and stretching of neorectal mesentery may play a role. Unfortunately, there is no therapeutic algorithm or gold standard treatment that may be used for ARS. Nevertheless, it is rational to use conservative therapy first and then resort to surgery. Drugs, rehabilitative treatment and sacral neuromodulation may be used; after failure of conservative methods, surgical treatment can be considered.
    MeSH term(s) Anal Canal/physiopathology ; Anal Canal/surgery ; Defecation/physiology ; Fecal Incontinence/etiology ; Fecal Incontinence/prevention & control ; Humans ; Recovery of Function/physiology ; Rectal Neoplasms/complications ; Rectal Neoplasms/physiopathology ; Rectal Neoplasms/surgery ; Reflex, Abnormal/physiology ; Treatment Outcome
    Language English
    Publishing date 2013-06-11
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-013-0220-5
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  7. Article ; Online: Obstructed defecation: the role of anorectal manometry.

    Pucciani, F / Ringressi, M N

    Techniques in coloproctology

    2011  Volume 16, Issue 1, Page(s) 67–72

    Abstract: Background: The aim of the study was to evaluate the clinical usefulness of anorectal manometry (AM) in patients affected by obstructed defecation (OD).: Methods: Between January 2007 and December 2010, 379 patients (287 women and 92 men) affected by ...

    Abstract Background: The aim of the study was to evaluate the clinical usefulness of anorectal manometry (AM) in patients affected by obstructed defecation (OD).
    Methods: Between January 2007 and December 2010, 379 patients (287 women and 92 men) affected by OD were evaluated. After a preliminary clinical evaluation, defecography and AM were performed. The results were compared with those from 20 healthy control subjects.
    Results: Overall anal resting pressure was not significantly different between patients and controls. Maximal voluntary contraction (MVC) data were significantly lower when compared with those of controls (P < 0.01). The straining test was considered positive in 143 patients. No significant difference was noted between patients and controls in maximal tolerated volume data. Patients had a significantly higher conscious rectal sensitivity threshold than controls (P < 0.02).
    Conclusions: A positive straining test, low MVC and impaired rectal sensation are the main abnormalities detected by AM in patients with OD.
    MeSH term(s) Adult ; Aged ; Anal Canal/diagnostic imaging ; Anal Canal/physiopathology ; Anus Diseases/complications ; Anus Diseases/physiopathology ; Ataxia/physiopathology ; Constipation/etiology ; Constipation/physiopathology ; Defecation/physiology ; Defecography ; Female ; Humans ; Intussusception/complications ; Intussusception/physiopathology ; Male ; Manometry ; Middle Aged ; Muscle Contraction ; Pelvic Floor Disorders/complications ; Pelvic Floor Disorders/physiopathology ; Rectocele/complications ; Rectocele/physiopathology ; Rectum/physiopathology ; Sensation/physiology ; Statistics, Nonparametric ; Young Adult
    Language English
    Publishing date 2011-12-16
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-011-0800-7
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  8. Article ; Online: Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse.

    Gallo, G / Martellucci, J / Pellino, G / Ghiselli, R / Infantino, A / Pucciani, F / Trompetto, M

    Techniques in coloproctology

    2018  Volume 22, Issue 12, Page(s) 919–931

    Abstract: Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been ... ...

    Abstract Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominance among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL and EMBASE. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Gastroenterology's Chronic Constipation Task Force. Five evidence levels were defined. The recommendations were graded A, B, and C.
    MeSH term(s) Advisory Committees ; Aged ; Colorectal Surgery/standards ; Consensus ; Digestive System Surgical Procedures/standards ; Disease Management ; Female ; Humans ; Incidence ; Italy ; Middle Aged ; Practice Guidelines as Topic ; Rectal Prolapse/epidemiology ; Rectal Prolapse/therapy ; Societies, Medical/standards
    Language English
    Publishing date 2018-12-15
    Publishing country Italy
    Document type Consensus Development Conference ; Journal Article ; Review
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-018-1908-9
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  9. Article ; Online: Obstructed defaecation: what is the role of rehabilitation?

    Pucciani, F / Reggioli, M / Ringressi, M N

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2012  Volume 14, Issue 4, Page(s) 474–479

    Abstract: Aim: The study was designed to evaluate the results of rehabilitative treatment in patients suffering from obstructed defaecation.: Method: Between January 2008 and July 2010, 39 patients (37 women, age range 25-73 years; and two men, aged 57 and 67 ... ...

    Abstract Aim: The study was designed to evaluate the results of rehabilitative treatment in patients suffering from obstructed defaecation.
    Method: Between January 2008 and July 2010, 39 patients (37 women, age range 25-73 years; and two men, aged 57 and 67 years) affected by obstructed defaecation were included in the study. After a preliminary clinical evaluation, including the Obstructed Defaecation Syndrome (ODS) score, defaecography and anorectal manometry were performed. All 39 patients underwent rehabilitative treatment according to the 'multimodal rehabilitative programme' for obstructive defaecation. At the end of the programme, all 39 patients were reassessed by clinical evaluation and anorectal manometry. Postrehabilition ODS scores were used to categorize patients arbitrarily into three classes, as follows: class I, good (score ≤ 4); class II, fair (score > 4 to ≤ 8); and class III, poor (score > 8).
    Results: After rehabilitation, there was significant improvement in the overall mean ODS score (P < 0.001). Thirty (76.9%) patients were included as class I (good results), of whom eight (20.5%) were symptom free. Five (12.8%) patients were considered class III. A significant postrehabilitative direct correlation was found between ODS score and pelvic surgery (ρ(s) = 0.54; P < 0.05). Significant differences were found between pre- and postrehabilitative manometric data from the straining test (P < 0.001), duration of maximal voluntary contraction (P < 0.001) and conscious rectal sensitivity threshold (P < 0.02).
    Conclusion: After rehabilitation, some patients become symptom free and many had an improved ODS score.
    MeSH term(s) Adult ; Aged ; Anal Canal/physiopathology ; Biofeedback, Psychology ; Combined Modality Therapy ; Constipation/diagnosis ; Constipation/physiopathology ; Constipation/rehabilitation ; Electric Stimulation Therapy ; Enema ; Exercise Therapy ; Female ; Humans ; Male ; Manometry ; Middle Aged ; Prospective Studies ; Rectum/physiopathology ; Severity of Illness Index ; Treatment Outcome
    Language English
    Publishing date 2012-04
    Publishing country England
    Document type Clinical Trial ; Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/j.1463-1318.2011.02644.x
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  10. Article ; Online: Rehabilitation of fecal incontinence: what is the influence of anal sphincter lesions?

    Pucciani, F / Raggioli, M / Gattai, R

    Techniques in coloproctology

    2012  Volume 17, Issue 3, Page(s) 299–306

    Abstract: Background: The aim of this study was to evaluate the results of rehabilitative treatment of incontinent patients with anal sphincter lesions in order to verify whether these lesions influence the outcome of rehabilitation.: Methods: Between January ... ...

    Abstract Background: The aim of this study was to evaluate the results of rehabilitative treatment of incontinent patients with anal sphincter lesions in order to verify whether these lesions influence the outcome of rehabilitation.
    Methods: Between January 2008 and June 2011, 48 patients [36 women, age range 51-77 years; 12 men, age range 57-70 years] affected by fecal incontinence were included in the study. After a preliminary clinical evaluation, including the Fecal Incontinence Severity Index (FISI) score, all patients were studied by means of endoanal ultrasound and anorectal manometry. Two patients groups were identified: Group 1 comprised 27 patients with sphincter lesions and Group 2 had 21 patients without sphincter lesions. All 48 underwent a multimodal rehabilitation program. At the end of the rehabilitation program, all patients were reassessed by means of clinical evaluation and anorectal manometry and their data were analyzed.
    Results: Although we obtained an overall significantly lower FISI score in all patients after rehabilitation (p < 0.001) when compared with pre-treatment values, our study revealed that patients with sphincter lesions had a significantly worse post-rehabilitative FISI score (p < 0.003) when compared with those patients with intact anal sphincters and that there is a linear relationship between post-rehabilitative FISI scores and severity of sphincter lesions (ρ s 0.69).
    Conclusions: These data suggest that rehabilitation may be less effective in patients affected by sphincter defects.
    MeSH term(s) Aged ; Anal Canal/diagnostic imaging ; Anal Canal/injuries ; Biofeedback, Psychology ; Endosonography ; Fecal Incontinence/diagnostic imaging ; Fecal Incontinence/rehabilitation ; Female ; Humans ; Male ; Manometry ; Middle Aged
    Language English
    Publishing date 2012-10-31
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-012-0923-5
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