ABSTRACT
Paradoxical contraction of the pelvic floor during attempts to defaecate is described as pelvic floor dyssynergia [anismus]. It is a behavioural disorder [no associated morphological or neurological abnormalities]; consequently, biofeedback training has been recommended as a behavioural therapy for such a disorder. The aim of the present study was to evaluate long-term satisfaction of patients diagnosed with pelvic floor dyssynergia after biofeedback. Sixty patients [35 females and 25 males] with a mean age of 30 +/- 12 years and a 4 year duration of constipation were included. Forty-five patients had normal colonic transit and 15 patients had slow colonic transit. History, physical examination and barium enema were done to exclude constipation secondary to organic causes. Colonic and pelvic floor functions [colon-transit time, anorectal manometry, EMG and defaecography] were performed before and after biofeedback treatments. Patients were treated on a weekly basis with an average of [6 +/- 2] sessions. At the end of sessions, 55 out of 60 patients [91.6%] reported a subjectively overall improvement. Symptoms of dyschezia were reported less frequently after biofeedback. Age and gender were not predictive factors of outcome. No symptoms at initial assessment were predictive for patient's satisfaction but the only factor of predictive value was the diagnosis of anismus and the motivated patient who wanted to continue the sessions. Biofeedback remains a morbidity free, low-cost and effective outpatient therapy for well-motivated patients complaining of functional constipation and diagnosed as pelvic floor dyssynergia
ABSTRACT
Background: intrathecally and epidurally administered morphine is frequently associated with pruritus. The aim of this study is to compare the efficacy of Nalbuphine. Propofol, and Ondansetron for treating intrathecal morphine induced pruritus after lower abdominal surgeries
Methods: In this prospective, randomized study 124 patients who developed moderate to severe pruritus after administration of intrathecal morphine were randomly allocated into three groups. One group received 3mg i.v nalbuphine, the second group received 20 mg i.v propolol and the third group received 8 mg i.v ondansetron. The improvement of pruritus and other adverse effects were determined at 15 mm after study drug administration. A decrease in pruritus score to 1-2 was considered a treatment success. Changes in the level of pain, sedation, hemodynamic values, and other side effects were checked regularly. Patients were rechecked 24 hours later for the presence or absence of pruritus
Results: There was no significant difference between the three groups as regards the demographic characteristics, the rout of morphine administration, and severity of pruritus at the beginning of the study. Nalbuphine group showed a success rate of 87.8% [pruritus score decreased to 1-2]. Propofol group showed success rate of 63.41% and 64.28% success in Ondansetron group. Among the successfully treated patients 7.31% in nalbuphine group, and 9.75% in propofol group reported recurrence of pruritus within 4 hours of study drug administration, while 11.9% in ondansetron group reported recurrence of pruritus within 5-7 hours of study drug administration. Among the successfully treated patients, none complained of residual pruritus 24 h later. Pain score insignificantly increased in both nalbuphine and propofol groups hut it did not change in ondansetron group. Sedation level significantly increased in both nalbuphinc and propolol groups but it did not change in ondansetron group. 1-lemodynarnic values remained stable, hemoglobin oxygen saturation did not change and no other side effects were observed in the three groups throughout the study
Conclusion: This study showed that Nalbuphine was superior to Propofol and Ondansetron for treatment of intrathecal morphine-induced pruritus