SIUCP consensus guidelines on obstructed defecation syndrome: when to rehabilitate, when to operate

Italian colon-proctology society (SIUCP) releases GRADE-based guidelines on obstructed defecation syndrome. Key threshold: surgery (stapled transanal resection or ventral mesh rectopexy) is indicated when symptom score is high AND defecography shows Oxford prolapse grade ≥3; tra…

• Delphi consensus among SIUCP expert panel; recommendations graded using GRADE methodology and PICO-structured questions across multiple rounds.
• Rehabilitation (biofeedback/pelvic floor therapy) is preferred first after medical therapy failure, especially for dyssynergic defecation; surgical escalation requires both high symptom burden and imaging-confirmed prolapse grade ≥3 on MR or other defecography.
• Primary limitation: these are society consensus guidelines, not a systematic review or RCT; evidence quality for individual recommendations varies and specific GRADE levels per statement are not detailed in the abstract.

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