{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T16:29:54Z","timestamp":1769012994921,"version":"3.49.0"},"reference-count":22,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,7,6]],"date-time":"2017-07-06T00:00:00Z","timestamp":1499299200000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Obstructed defaecation (<jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content>) has a high prevalence and high disease impact; however, patients often experience suboptimal management. This problem reflects the complex pathophysiology of <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content> as well as health service delivery factors. This study aimed to identify the factors that act as a barrier to effective management of <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content> as perceived by specialist colorectal surgeons treating this disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A postal questionnaire was administered to a bi\u2010national sampling of colorectal specialists in Australia and New Zealand who were registered with their specialty society. Questions addressed variables relevant in <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content> management, including clinical access, decision\u2010making, patient factors and surgeon experience and perceptions, and used Likert scales. Statistical analyses compared surgeon practice variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The response rate was 68.5% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0113). Most surgeons managed <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content> (94%), and preferred to treat <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content> patients themselves (87%); however, 33% of these respondents were dissatisfied with their management, 46% felt they lacked management expertise and 33% stated they had inadequate expertise in <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content> investigations. Clinical investigation services were more limited in private than public practice, and many surgeons lacked access to biofeedback (31%). Other barriers included heterogeneity in decision\u2010making by surgeon age and practice location (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05), dual pathologies (e.g. irritable bowel syndrome) and psychological factors, and limited uptake of multidisciplinary services and standardized (Rome) diagnostic criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Barriers to <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content> management include surgeon\u2010specific factors, patient\u2010specific factors and healthcare access factors. Increased utilization of pelvic floor and multidisciplinary services, increased training and standardization of <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content> investigations and improved access to specialist investigations and allied\u2010health management services could improve outcomes for <jats:styled-content style=\"fixed-case\">OD<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13665","type":"journal-article","created":{"date-parts":[[2017,3,20]],"date-time":"2017-03-20T14:26:59Z","timestamp":1490020019000},"page":"649-655","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Barriers to the management of obstructed defaecation according to colorectal surgeons"],"prefix":"10.1111","volume":"19","author":[{"given":"N.","family":"Al\u2010Mozany","sequence":"first","affiliation":[{"name":"Surgical Outcomes Research Centre (SOuRCe) Sydney Local Health District and Sydney School of Public Health University of Sydney Sydney New South Wales Australia"},{"name":"Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia"},{"name":"Department of Surgery University of Auckland Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Wright","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Research Centre (SOuRCe) Sydney Local Health District and Sydney School of Public Health University of Sydney Sydney New South Wales Australia"},{"name":"Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"O'Grady","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Auckland Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. J.","family":"Young","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Research Centre (SOuRCe) Sydney Local Health District and Sydney School of Public Health University of Sydney Sydney New South Wales Australia"},{"name":"Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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