2017 ICI Pathway for bowel symptoms and prolapse surgery
In 2017 the International Collaboration on Incontinence (ICI 2017) committee on the surgical management of prolapse produced this guideline statement that summarises a planned approach to the management of bowel symptoms.
Basically, the flow diagram states:
1. Women without bowel symptoms should be managed as per the POP surgical guideline.
2. Women with obstructed defecation (incomplete evacuation or those using digital pressure to assist in evacuation of their bowel) with a rectocele should be managed as per the POP surgical guideline.
3. Those with obstructed defecation without rectocele should be investigated to exclude rectal prolapse (rectum extruding from the anus). If rectal and vagin*l prolapse present combined gynaecological and colorectal surgery could be considered.
4. Women with faecal incontinence require colorectal diagnostics as discussed above and those with rectal prolapse as a cause may require combined gynaecology and colorectal surgery. Other causes of fecal incontinence such as anal sphincter injury or nerve damage will require separate colorectal interventions in addition to the gynaecology intervention.
5. Women with vagin*l prolapse and constipation should understand
- The prolapse is likely to be at least partially caused by the constipation
- The constipation will not be resolved by the prolapse surgery
- Ongoing post-operative management of constipation is required to minimise the risk of prolapse recurrence.
