Güncel Proktoloji: Anorektal Hastalıklar ve Modern Yaklaşımlar

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PELVİK TABAN HASTALIKLARI VE OBSTRİKTİF DEFEKASYON SENDROMU

Dr. Öğr. Üyesi Miraç İlker PALA

Medipol Üniversitesi Tıp Fakültesi, Pendik Hastanesi, Genel Cerrahi AD, İstanbul, Türkiye

ÖZET

Pelvik taban hastalıkları ve obstrüktif defekasyon sendromu (ODS), gerek batılı ülkelerde gerekse Türkiye?de sık görülen rahatsızlıklardır. ODS, rektumun etkili ve hızlı bir şekilde boşaltılamadığı pelvik taban bozukluklarının bir alt tipidir. Kadınların %20’den fazlası hayatları boyunca en az bir pelvik taban hastalığı yaşamaktadır ve yaş, doğum sayısı ile obezite bu hastalıkların görülme sıklığını artıran faktörlerdir. Normal dışkılama süreci; rektumun dışkı ile dolması, rektoanal inhibitör refleksin (RAIR) aktivasyonu ve dışkılama sürecinin son evresinde levator ani kasının gevşemesiyle gerçekleşir. Bu fizyolojik sürecin herhangi bir aşamasındaki bozukluk, ODS’ye neden olabilir. Kabızlık etiyolojisi farklı nedenlere dayanmaktadır. Kolonik inertia (yavaş geçişli kons- tipasyon), konstipasyon predominant irritabl bağırsak sendromu (İBS) ve pelvik taban disfonksiyonu (ODS) yaygın sebeplerdir. ODS hastalarında genellikle aşırı ıkınma, tam boşaltamama ve perineye el ile destek olma gibi belirtiler görülmektedir. ODS tanısında ayrıntılı anamnez ve fizik muayene temel olmakla birlikte kolonik transit testi, defekografi ve anorektal manometri gibi testler kullanılmaktadır. Bu testler, fonksiyonel kabızlığın alt tiplerinin ayrımını yapmada ve pelvik taban fonksiyonlarını değerlendirmede kullanılır. ODS’nin tedavisi genellikle konservatif yöntemlerle başlar. Diyet değişiklikleri (lif ve sıvı tüketiminin artırılması), yaşam tarzı değişiklikleri ve pelvik taban fizyoterapisi, tedavi seçenekleri arasındadır. Pelvik taban fizyoterapisi ve biofeedback tedavisi, kas koordinasyonunu iyileştirerek semptomları azaltmada etkili olabilir. Ancak, her hastada yeterli yanıt alınamayabilir. Cerrahi seçenekler, konservatif yöntemlerin yetersiz kaldığı durumlarda düşünülmektedir. Laparoskopik ventral mesh rektopeksi (LVMR) gibi cerrahi işlemler, yapısal bozuklukları düzeltmek için tercih edilebilir, ancak bu yöntemlerin komplikasyon riskleri bulunmaktadır. Sonuç olarak, ODS ve pelvik taban hastalıkları, multifaktöryel rahatsızlıklar olup tanı ve tedavide hem konservatif hem de cerrahi yaklaşımlar gerektire- bilir. Hastalar, tedavi seçenekleri ve beklentiler konusunda ayrıntılı şekilde bilgilendirilmelidir.

Anahtar Kelimeler: Rektosel; Pelvik taban; Pelvik taban kusurları; Konstipasyon

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