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.