Disfunções evacuatórias após a cirurgia bariátrica: avaliação clínica, funcional e resposta à fisioterapia pélvica.

Abstract

Obesity is a major public health concern and is associated with multiple comorbidities, including pelvic floor muscle dysfunctions (PFMD), which negatively affect quality of life. Although bariatric surgery (BS) is considered one of the most effective interventions for the treatment of obesity, further studies are needed to investigate its effects on anorectal function, particularly regarding the occurrence of symptoms, functional alterations, and therapeutic approaches during the postoperative period. The aim of this thesis was to analyze the occurrence of defecatory dysfunctions and functional alterations in patients who underwent bariatric surgery, as well as to evaluate the effects of pelvic floor physiotherapy combined with electromyographic biofeedback on the treatment of these alterations. This thesis comprised a retrospective observational study and a longitudinal physiotherapeutic intervention study conducted at a gastroenterology and pelvic floor physiotherapy center in Cascavel, Paraná, Brazil. Data were collected between January and September 2022. A total of 1,639 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy between 2015 and 2019 were included, comprising 1,184 women (72.3%) and 455 men (27.7%). In the first study, the occurrence of anorectal symptoms and anorectal manometric alterations was investigated, with comparative analyses according to sex. In the second study, patients presenting symptoms of defecatory dysfunction who were referred for pelvic floor physiotherapy combined with electromyographic biofeedback were evaluated using the Constipation Scoring System (CSS), the Cleveland Clinic Fecal Incontinence Score (CCFIS), and electromyographic assessment before and after the intervention. Statistical analyses were performed using a significance level of 5% (p < 0.05). Among the 1,639 patients evaluated, 477 (29.1%) presented anorectal symptoms after bariatric surgery, with constipation being the most frequently reported symptom. Of these, 91 patients underwent anorectal manometry, and 64 received physiotherapeutic treatment. Differences in symptom profiles were observed between men and women; however, manometric alterations, such as sphincter hypotonia and anismus, occurred similarly in both sexes. Patients who underwent physiotherapeutic intervention showed significant improvement in constipation and fecal incontinence, accompanied by increased pelvic floor muscle activity. In conclusion, anorectal symptoms are common after bariatric surgery and are associated with relevant functional alterations. Furthermore, pelvic floor physiotherapy combined with electromyographic biofeedback proved to be an effective strategy for treating these dysfunctions.