Multidisciplinary approach and rehabilitation practice for defecatory disorders in Italy: a snapshot survey on behalf of the Italian Society of Colorectal Surgery (SICCR)

Background: Defecatory disorders and pelvic floor dysfunctions are prevalent and significantly impact quality of life. Due to their multifactorial etiology, a multidisciplinary approach and pelvic floor rehabilitation (PFR) are recommended, however their implementation varies widely. This study aimed to evaluate current practices in multidisciplinary management and rehabilitation strategies for defecatory disorders in Italy. Methods: A 25-item, web-based survey was distributed to members of the Italian Society of Colorectal Surgery between May and July 2024. The questionnaire explored the professional background of the responders, the availability and composition of the multidisciplinary team (MDT), the use of PFR and related clinical practices. Results: A total of 183 colorectal surgeons from 20 Italian regions completed the survey. Only 49% reported the presence of a structured MDT, with frequent absence of a urologist, gastroenterologist, and radiologist. Combined pelvic floor surgery was rarely performed, despite its clinical advantages. PFR services were available in just over half of the centers, often without psychological or nutritional support. Rehabilitative techniques varied, with volumetric rehabilitation and tibial nerve stimulation being underutilized. Referral rates to rehabilitation remained low, regardless of institution type or surgical experience. Despite the lack of standardized protocols, a quarter of responders utilized perioperative rehabilitation in the context of rectal prolapse surgery. Conclusions: Significant variability exists in the multidisciplinary and rehabilitative management of defecatory disorders in Italy. To optimize care, greater integration of MDT, wider access to a standardized PFR and the adoption of combined surgical approaches are needed.