{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T03:13:22Z","timestamp":1768274002279,"version":"3.49.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2006,8,24]],"date-time":"2006-08-24T00:00:00Z","timestamp":1156377600000},"content-version":"vor","delay-in-days":0,"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":[[2007,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Objective\u2002<\/jats:bold> Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an \u2018iceberg syndrome\u2019 characterized by \u2018underwater rocks\u2019 or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders, in order to alert the clinician of these and minimize failures.<\/jats:p><jats:p><jats:bold>Method\u2002<\/jats:bold> One hundred consecutive constipated patients with OD symptoms, 81 women, median age 52\u2003years, underwent perineal examination, proctoscopy, anorectal manometry and anal\/vaginal ultrasound (US). Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultations. Symptoms were graded using a modified 1\u201320 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel \u2018iceberg diagram\u2019. The type of treatment, whether conservative or surgical, was also recorded.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> Fifty\u2010four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD\u2010related diseases, 66 patients had at least three of them: anxiety\u2013depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33%, respectively). The median constipation score was 11 (range 2\u201320), the median number of \u2018occult disorders\u2019 was 5 (range 2\u20138). Conservative treatment was carried out in most cases. Surgery was carried out in 14 (14%) patients.<\/jats:p><jats:p><jats:bold>Conclusion\u2002<\/jats:bold> The novel \u2018iceberg diagram\u2019 allowed the adequate evaluation of OD\u2010related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery.<\/jats:p>","DOI":"10.1111\/j.1463-1318.2006.01094.x","type":"journal-article","created":{"date-parts":[[2006,8,29]],"date-time":"2006-08-29T18:33:47Z","timestamp":1156876427000},"page":"452-456","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":69,"title":["A prospective evaluation of occult disorders in obstructed defecation using the \u2018iceberg diagram\u2019"],"prefix":"10.1111","volume":"9","author":[{"given":"M.","family":"Pescatori","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Spyrou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Pulvirenti d'Urso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,8,24]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0626-8"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-003-0574-0"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02056950"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-003-0026-4"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02050415"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2004.00578.x"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0800-z"},{"key":"e_1_2_5_9_2","first-page":"15","article-title":"Rectoceles and the \u2018\u2018iceberg sindrome\u2019\u2019","volume":"13","author":"Pescatori M","year":"2003","journal-title":"Urodinamica"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-003-0572-2"},{"key":"e_1_2_5_11_2","volume-title":"Complex Anorectal Disorders: Investigation and Management","author":"Wexner SD","year":"2004"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-005-0758-x"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1463-1318.2002.00322.x"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800690813"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01645311"},{"key":"e_1_2_5_16_2","first-page":"15","article-title":"The draw\u2010the\u2010family test in the diagnosis of colorectal psychosomatosis","volume":"25","author":"Miliacca C","year":"2006","journal-title":"Pelvi-Perin, RICP"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0582-3"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.2002.02121.x"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2004.00758.x"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5092"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1463-1318.2006.01094.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1463-1318.2006.01094.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T16:15:14Z","timestamp":1696954514000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1463-1318.2006.01094.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,8,24]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2007,6]]}},"alternative-id":["10.1111\/j.1463-1318.2006.01094.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1463-1318.2006.01094.x","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,8,24]]},"assertion":[{"value":"2006-08-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}