Psyllium fiber vs. placebo in early treatment after STARR for obstructed defecation: a randomized double-blind clinical trial.

BACKGROUND

Previous Literature has never evaluated the effectiveness of fiber intake after surgery for obstructed defecation in improving residual constipation and defecation urgency.

METHODS

From May 2010 to June 2011, 65 patients were randomly assigned to either the active group (N.=32) or placebo group (N.=33) receiving 3.5 g/day of pure Psyllium fiber or inert compound respectively. During the 6-month follow-up score systems were evaluated: Longo's Obstructed Defecation Syndrome Score, Cleveland Constipation Score; Wexner incontinence Score and Visual Analogic Scale. We also recorded the incidence of postoperative defecation urgency.

RESULTS

Active group reported less constipation at 1 week (ODS: 6.25±3.55 vs. 11.94±4.99, P<0.01-CCS: 6.59±2.65 vs. 15.10±3.33, P<0.01) and 6 months (ODS: 3.40±5.26 vs. 4.97±4.21, P<0.05-CCS: 5.00±3.82 vs. 6.63±3.68; P<0.01). Wexner Score was better at t-test in the treatment group (difference from baseline: 0.5 vs. 2.70, P<0.01 after 1 week and -0.17 vs. 1.33, P<0.01 after 6 months). Defecation urgency was less frequent in the treatment group (15.62% vs. 42.42%, P<0.05 at the χ2 Test).

CONCLUSIONS

Early treatment with Psyllium fiber improves early and 6 month results after stapled transanal rectal resection, both in terms of residual constipation and fecal incontinence. It also reduces postoperative defecation urgency.