Background

Anismus is one of the common causes of obstructed defecation syndrome (ODS). The present review aimed to assess the efficacy and safety of the puborectalis muscle (PRM) division in the treatment of anismus.

Methods

PubMed, Scopus, Web of Science, and Cochrane Library were searched for studies that assessed the outcome of PRM division in the treatment of anismus. The main outcome measures were subjective improvement in ODS, decrease in Wexner constipation score and ODS score, and complications, namely faecal incontinence (FI).

Results

Ten studies (204 patients; 63.7% male) were included. The weighted mean rate of initial subjective improvement across randomised trials was 97.6% (95%CI: 94-100) and across non-randomised studies was 63.1 (95%CI: 39.3-87). The weighted mean rate of 12-month improvement across randomised trials was 64.9% (95%CI: 53.3-76.4) and across non-randomised studies was 55.9% (95%CI: 30.8-81). The weighted mean rate of FI across randomised trials was 12.1% (95%CI: 4.2- 20) and across non-randomised studies was 10.4% (95%CI: 1.6-19.3). Male sex and unilateral PRM division were significantly associated with recurrence of symptoms after PRM division. Bilateral PRM division, posterior division, complete division, and concomitant sphincterotomy were significantly associated with FI after PRM division.

Conclusions

Using PRM division for treatment of anismus was followed by some initial improvement in ODS symptoms which decreased to <60% 12 months after PRM division. The mean rate of FI after PRM division of 10-12% is a limitation of the technique. More well-designed trials are needed to verify the outcome of PRM division in the treatment of anismus.