The Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of obstructed and ineffective defecation syndrome

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) on the diagnosis and management of obstructed defecation syndrome (ODS), with the purpose of guiding physicians in the selection of the most appropriate treatment option. A panel of experts was appointed by the Board of the SIUCP to develop key questions addressing the main topics related to the management of ODS and to perform an accurate literature search for each topic, in order to provide evidence-based answers and to summarize them in structured statements. All clinical questions were discussed by the expert panel over multiple rounds using the Delphi approach, and consensus among the experts was achieved for each statement. The questions were formulated according to PICO (patients, intervention, comparison, outcome) criteria, and the statements were developed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In patients with ODS refractory to first-line medical therapy, rehabilitation may be considered as a therapeutic option, particularly in cases of dyssynergic defecation, whereas a surgical approach may be indicated in patients with a high symptom score and an Oxford prolapse grade system score ≥3 on defecography (using magnetic resonance imaging or another modality). Surgical options include stapled transanal rectal resection and ventral mesh rectopexy, eventually combined, respectively, with pelvic organ prolapse suspension and sacrocolpopexy in the presence of multicompartment pelvic prolapse. A transverse perineal support procedure may be considered in the presence of excessive perineal descent. In patients with recurrent symptoms after surgery, transanal irrigation may represent a useful therapeutic option.

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Publication Details

Journal
Annals of Coloproctology
Published
2026-04-28
DOI
https://doi.org/10.3393/ac.2025.00899.0128
Primary Topic
Anorectal Disease Treatments and Outcomes
Type
article
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article

The Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of obstructed and ineffective defecation syndrome

Elisa Palladino, G Lamanna, Nadine Osman, Antonio Canero et al.
Annals of Coloproctology
Anorectal Disease Treatments and Outcomes
article

The Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of obstructed and ineffective defecation syndrome

Elisa Palladino, G Lamanna, Nadine Osman, Antonio Canero, Giovanni Ferreri, Cristina Folliero, Massimo Pezzatini, Francesca Da Pozzo, Alberto Di Leo, Angela Pezzolla, Alessandro Bussotti, Natale Calomino, Maurizio Grillo, Raffaella Marina Di Renzo, Francesca Iacobellis, Gabriele Naldini, Domenico Izzo, Leonardo Lenisa, Maria Michela Di Nuzzo, Corrado Rispoli, Nando Gallese, Silvia Marola, Massimo Antropoli, Francesca Ascari, Andrea Braini, Michele D’Ambra, G Pagano, Nicola Antonacci, Sergii Girnyi, Rita Laforgia, Adolfo Renzi, Claudio Gambardella, Gianluca Minieri, Fabrizio Foroni, Roberto Picheo, Marta Mozzon, Antonio Vallo, Giacomo Sarzo, Guido Benegiamo, Mauro Maglio, Federico Maria Mongardini, Luigi Brusciano, Luigi Marano, Sergio Agradi, Roberto Peltrini, L. Losacco, M Mongardini, Fabrizio Gambarini, Giuseppe Calabrò, Giuseppe Candilio, E Cudazzo, Alfredo Annicchiarico, Monica Urbani, Pasquale Talento, Francesco Ghiglione, Luigi Monaco, A. Marazzi, Simona Ascanelli, Andrea Lauretta, Tomasz Cwalinski, Michele Lanza, Riccardo Brachet Contul, Alessio Palumbo, U. Favetta, Andrea Grego, Matteo Zuin, F. Milazzo, Marcello Gasparrini, Roberto Rizzato, Carmine Antropoli, Alessandro Stazi, Francesca Babic, Angelo Stuto, Michele Schiano di Visconte, Benedetto Neola, Laura Chimisso, G. Frezza, Luana Franceschilli, Bruno Masci, Vinicio Mosca, Maria Laura Sandoval Sotelo, Gianmattia Terracciano, Claudio Eduardo Fernando Antonio Pagano, Ilaria Ferrante, L Vicenzo, Umberto Cocozza, Silvia Malerba, Giuseppe D’Oriano, Alfredo Giordano, Diletta Paola Iovino, Aurora Marotta, Mariangela Desantis, Luigi Pellecchia, Paolino Mauro, Michele Pinto, Carmelo Geremia, Alfredo Ansalone, Antonio Colangelo, Costantino Magnani, Giovanni Greco
article en

Abstract

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) on the diagnosis and management of obstructed defecation syndrome (ODS), with the purpose of guiding physicians in the selection of the most appropriate treatment option. A panel of experts was appointed by the Board of the SIUCP to develop key questions addressing the main topics related to the management of ODS and to perform an accurate literature search for each topic, in order to provide evidence-based answers and to summarize them in structured statements. All clinical questions were discussed by the expert panel over multiple rounds using the Delphi approach, and consensus among the experts was achieved for each statement. The questions were formulated according to PICO (patients, intervention, comparison, outcome) criteria, and the statements were developed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In patients with ODS refractory to first-line medical therapy, rehabilitation may be considered as a therapeutic option, particularly in cases of dyssynergic defecation, whereas a surgical approach may be indicated in patients with a high symptom score and an Oxford prolapse grade system score ≥3 on defecography (using magnetic resonance imaging or another modality). Surgical options include stapled transanal rectal resection and ventral mesh rectopexy, eventually combined, respectively, with pelvic organ prolapse suspension and sacrocolpopexy in the presence of multicompartment pelvic prolapse. A transverse perineal support procedure may be considered in the presence of excessive perineal descent. In patients with recurrent symptoms after surgery, transanal irrigation may represent a useful therapeutic option.

Annals of ColoproctologyVol. 42(2)
University of Siena (IT), University of Udine (IT), Humanitas University (IT), University of Padua (IT), University of Trieste (IT), United States Government Accountability Office (US), University of Cagliari (IT), University of Campania "Luigi Vanvitelli" (IT), University of Ferrara (IT), University of Pavia (IT), Santa Maria Nuova Hospital (IT), Policlinico Umberto I (IT), CTO Hospital (IT), Nicolaus Copernicus University (PL), Azienda Unita' Sanitaria Locale Di Modena (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), ASL Roma (IT), Istituto Ramazzini (IT), Ospedale di Cattinara (IT), AULSS 2 Marca Trevigiana (IT), IRCCS Policlinico San Donato (IT), Azienda Unità Sanitaria Locale di Ferrara (IT), Ospedale San Carlo (IT), Ferrarotto Hospital (IT), Ospedale Sant Antonio (IT), Fatebenefratelli Hospital (IT), Ospedale Humanitas Gradenigo (IT), Azienda Ospedaliera S.Giuseppe Moscati (IT), Azienda Ospedaliera Santa Maria Degli Angeli (IT), Ospedale San Paolo (IT), Ospedale “M. Bufalini” di Cesena (IT), Ospedale Santa Maria (IT), CTO Andrea Alesini (IT), Regione Puglia (IT), Ospedale Madonna Delle Grazie (IT), Presidio Ospedaliero (IT), ASST Melegnano e della Martesana (IT), Arcispedale Sant'Anna (IT), University of Campania "Luigi Vanvitelli" (IT), Casa di cura Pierangeli (IT), Centro di Riferimento Oncologico (IT), IRCCS San Camillo Hospital (IT), Azienda USL della Valle d’Aosta (IT), University of Aosta Valley (IT), Villa Pineta Hospital (IT), Villa Melitta (IT), Ospedale Monaldi (IT), FIP Industriale (Italy) (IT), Ospedale Santa Maria della Misericordia di Rovigo (IT), Casa di Cura Città di Roma (IT), Ospedale Buon Consiglio Fatebenefratelli (IT), Euromedic (PL), Fondazione Humanitas per la Ricerca (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Sanitaria Locale Roma 3 (IT), IRCCS Humanitas Research Hospital (IT), Ospedale San Pietro Fatebenefratelli (IT), Ospedale di Santa Maria dei Battuti (IT), University of Bari Aldo Moro (IT), University of Reggio Calabria (IT), University of Naples Federico II (IT), Polish Academy of Sciences (PL)
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Anorectal Disease Treatments and Outcomes
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