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Objective To explore the clinical effects of biofeedback (BF) therapy on functional constipation (FC) caused by pelvic floor dys-synergia (PFD).Methods Forty patients with FC caused by PFD were enrolled and given BF therapy twice a week for 5 weeks.Constipation symptom scores and anal motility were recorded before and after the therapy.Results All the patients enrolled finished the BF therapy,with a total effectiveness rate of 80％.Both the constipation symptom scores and anal residual pressure during defecation had decreased significantly after therapy.Rectal gradient pressure,however,had increased significantly.Conclusion Biofeedback can relieve the clinical symptoms of FC and improve pelvic floor coordination during defecation.It is worth applying in clinical practice.
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Objective To evaluate the clinical diagnostic value of pelvic floor sEMG in pelvic floor dyssynergia (PFD) by using receiver operating characteristic curve (ROC curve). Methods The pelvic floor sEMG of 90 patients with PFD and 101normal controls were determined by the Glazer protocol.Parameters including amplitude (AVG),coefficient of variance (CV),onset time and median frequency (MF),and the ROC curve werealso investigated. Results Compared to the control group,the PFD group had a higher AVG of pre-baseline (P < 0.05), a lower AVG during Flick and Tonic steps(P < 0.05), and ahigher CV duringTonic and Endurance steps(P < 0.05).The area under curve(AUC) of CV duringthe tonic step was 0.883 withthe best cut-off of 0.355, and with sensitivity of 88.4%and the specificity of 71.1%, respectively; The AUC of CV duringEndurance step was 0.825 withthe best cut-off of 0.305, and with the sensitivity of 84.9%and the specificity of 67.8% , respectively. Conclusion The CVs of the tonic and the endrnace phases can be used as valuable clinical values in diagnosis of PFD.
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PURPOSE: Defecography is known to be a sensitive and specific measurement of pelvic floor dyssynergia (PFD). However, its standardized parameter for diagnostic analysis is still incomplete. We attempted to determine which defecographic findings are most significant for PFD, and how closely they match other physiologic tests and clinical symptoms of functional pelvic outlet obstruction. METHODS: Ninety-six patients with constipation who completed work-up of their symptoms with defecography, anorectal manometry and electromyography (EMG) were included in the study. Internal consistency of defecographic findings, and agreements between defecographic findings and results of other tests were statistically analyzed (Crohnbach's alpha, Cohen's kappa, respectively). RESULTS: Of the 96 patients evaluated, obstructive symptoms of constipation were obvious in 35 (36.5%) by obstructive symptom score. As known defecographic findings for PFD, poor opening of the anal canal was found in 33 (34.4%), persistent posterior angulation of the rectum in 33 (34.4%), and poor emptying of the rectum in 61 (63.5%). Manometric defecation index, manometric evacuation index, and EMG findings compatible with PFD were in 81 (84.4%), 72 (75%), and 73 (76%), respectively. Internal consistency of three defecographic findings was good (alpha = 0.78). Agreements between each defecographic findings and each result of other tests were all poor. CONCLUSION: Among known defecographic findings for PFD, one specific finding cannot be considered more important than the others for its diagnosis. It is hard to expect consistent results of various diagnostic tests and to predict the presence of defecographic PFD by use of anorectal manometry, EMG, or even by clinical symptoms.
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Humans , Anal Canal , Ataxia , Constipation , Defecation , Defecography , Diagnostic Tests, Routine , Electromyography , Manometry , Pelvic Floor , RectumABSTRACT
ObjectiveTo study the effect of two different delivery methods on the post-partum pelvic floor muscle strength. Methods56 primipara were divided into two groups according to different delivery methods,34 primipara took elective caesarean section,while 22 took natrual delivery. In 1 ～ 6 months after childbirth, they were respectively undertaken pelvic floor dyssynergia and urinary incontinence after childbirth scoring, then carried out pelvic muscle testing. ResultsThe elective caesarean section group had 4 and 3 primiparas who were pelvic floor dyssynergia, the rate of pelvic floor dyssynergia of elective caesarean section group was 11.8％ and 8.882％, and 8 and 6 primiparas of natrual delivery had pelvic floor dyssynergia, the rate of pelvic floor dyssynergia of natrual delivery group was 36.4％ and 27.3％ at one and three months post-partum seperately,tbe rate of pelvic floor dyssynergia between elective caesarean section group and natrual delivery group was statistically different( P ＜ 0.05). The elective caesarean section group had 3 and 2 primiparas who were urinary incontinence after childbirth, the rate of urinary incontinence after childbirth of elective caesarean section group was 8.8％ and 5.9％ ,and 5 and 4 primiparas of natrual delivery had urinary incontinence after childbirth, the urinary incontinence after childbirth of natrual delivery group was 27.7％ and 18.2％, the rate of urinary incontinence after childbirth between elective caesarean section group and natrual delivery group was statistically different(P ＜0.05). The elective caesarean section group had 19 and 25 primiparas who got ≥3 score in pelvic floor testing,take up 55.8％ and 77.5％ in the elective caesarean section group,the natrual delivery group had 8 and 10 primiparas who got ≥3 score in pelvic floor testing,take up 36.4％ and 45.4％ in the natrual delivery group,the rate of ≥3 score in pelvic floor testing of elective caesarean section group was much more than natrual delivery group, and it was statistically different ( P ＜ 0.05 ). ConclusionRelative to natrual delivery, the rate of pelvic floor dyssynergia and urinary incontinence after childbirth was much less in elective caesarean section, and the pelvic floor testing score was more in elective caesarean section.
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La constipación es un síntoma frecuente. La mayoría de los pacientes responden a medidas conservadoras. Entre los que no responden el subtipo más frecuente es la disfunción anorrectal, que se refiere a la evacuación incompleta de la materia fecal del recto debido a la contracción paradójica o a la falta de relajación de los músculos del piso pelviano durante el esfuerzo, la denominada defecación disinérgica. Se la considera un trastorno del comportamiento, dado que no se ha observado ninguna enfermedad orgánica relacionada. Se ha recomendado el tratamiento de biorretroalimentación, que involucra un procedimiento dedicado a enseñar a los pacientes cómo relajar los músculos del piso pelviano y mejorar los empujes cuando se intenta defecar. Algunos ensayos no controlados habían sugerido que la biorretroalimentación era beneficiosa en la defecación disinérgica tanto en niños como en adultos. Recientemente se publicaron tres ensayos controlados aleatorizados en adultos, que proporcionaron resultados concordantes. Se demostró consistentemente que es un tratamiento eficaz y específico para la defecación disinérgica. Se demostró que el re entrenamiento es mucho más eficaz que el macrogol, el diazepam (relajante del músculo esquelético) y los procedimientos de relajación simulados en la constipación secundaria a defecación disinérgica. Hemos obtenido pruebas inequívocas de que la terapia de biorretroalimentación es el tratamiento de elección en la defecación disinérgica de los adultos constipados.
Constipation is a commonly reported symptom. Mostpatients respond to conservative measures. Among nonresponders,outlet dysfunction is the most commonsubtype. It refers to incomplete evacuation of fecal materialfrom the rectum due to paradoxical contraction orfailure to relax the pelvic floor muscles when straining,the so-called dyssynergic defecation. It is considered abehavioral disorder, since no related organic disease hasbeen evidenced. Biofeedback treatment has been recommended. Biofeedback involves use of dedicatedmachinery to teach patients how to relax the pelvic floormuscles and to improve pushing effort when strainingto defecate. A number of uncontrolled trials hadsuggested biofeedback to be beneficial in dyssynergicdefecation both in children and in adults. This has notbeen confirmed by controlled randomized trials inchildren. In adults, three randomized controlled trials havebeen recently published giving concordant results. Biofeedback has been consistently shown to be an effective and specific therapy for dyssynergic defecation. Retraining has been shown to be significantly more effective than macrogol, diazepam (skeletal musclerelaxant), and sham relaxation procedures in constipation secondary to dyssynergic defecation. We have gainedunequivocal evidence that biofeedback therapy is the treatment of choice for dyssynergic defecation inconstipated adults.
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Constipation , Electromyography , Defecation , Pelvic FloorABSTRACT
PURPOSE: Recently well-developed anorectal function tests have revealed that there is an obvious pelvic floor dyssynergia (PFD) pattern in pediatric patients with constipation, as well as in adult's. The use of biofeedback therapy (BT) has been widely implemented in adult PFD patients; however, this approach has only rarely been considered for pediatric PFD patients. Therefore, we assessed the effectiveness of BT in children with PFD. METHODS: We studied 70 children with PFD, who were referred to the department of pediatrics at the Asan Medical Center for the management of soiling or chronic constipation from September 2002 to February 2005. Diagnosis of PFD and assessment of the efficacy of BT for PFD treatment were carried out along with several ano-rectal function tests (cine-defecography, ano-rectal manometry, balloon expulsion test and intra-anal EMG); in addition, a questionnaire was administered. The BT based intra-anal EMG was performed. A follow-up telephone interview was performed more than 6 months later. RESULTS: Most of the symptoms and results of the ano-rectal function tests were statistically improved after BT. In comparisons between the BT and control groups (BT refusal group due to poor compliance), the symptoms were statistically improved at follow-up. Therefore, for the short- term improvement of symptoms, BT was better than conservative therapy alone. The negative feelings associated with ano-rectal function testing and BT were directly associated with failure or success of therapy. CONCLUSION: Pediatric patients with constipation or soiling that presented with an obvious PFD pattern showed that BT was a useful therapeutic tool for rapid improvement of symptoms.
Subject(s)
Adult , Child , Humans , Ataxia , Biofeedback, Psychology , Constipation , Diagnosis , Disulfiram , Follow-Up Studies , Interviews as Topic , Manometry , Pediatrics , Pelvic Floor , Surveys and Questionnaires , SoilABSTRACT
BACKGROUND AND AIMS: PFD is effectively treated by biofeedback therapy. For the definite diagnosis of PFD, defecography, colon transit time study, balloon expulsion testing, and anorectal manometry are needed. However, these methods are of high cost and cause discomfort to patients. Moreover, definite diagnosis cannot be made by a single test due to a high false positive rate. In general, several symptoms linked with problems in defecating, including excessive straining, the sensation of incomplete evacuation, and applying pressure around the anus or the vagina to facilitate defecation, are known to be frequently associated with PFD. The aim of this study was to evaluate whether specific clinical parameters could differentiate patients with PFD from other constipated patients. METHODS: An organized questionnaire including 47 questions that contained subjective symptoms, past medical history, and eating habits was designed. The questionnaire was distributed to 132 patients who fulfilled Rome II criteria for functional constipation. Digital rectal examination was conducted by a single gastroenterologist. RESULTS: Among 132 patients, 45 patients were categorized as PFD, 26 patients as slow transit constipation (STC) and 17 patients as normal transit constipation. Among specific questions about constipation, hard stool was more frequently noted in patients with STC than PFD (p<0.05), and the frequency of defecation was lower in patients with STC than PFD (p<0.05). However, the symptoms suggesting difficult defecation were not different between the two groups. The percentage of paradoxical contraction by digital rectal examination was not different between the two groups (PFD: 57.1% vs. STC: 48.0%). CONCLUSION: The symptoms and signs suggesting difficult defecation could not differentiate PFD from STC and normal transit constipation, although several parameters were different among the three subgroups. Therefore, anorectal physiologic tests are needed for the diagnosis of PFD.
Subject(s)
Humans , Anal Canal , Ataxia , Biofeedback, Psychology , Colon , Constipation , Defecation , Defecography , Diagnosis , Digital Rectal Examination , Eating , Manometry , Pelvic Floor , Sensation , Time and Motion Studies , Vagina , Surveys and QuestionnairesABSTRACT
BACKGROUND AND AIMS: PFD is effectively treated by biofeedback therapy. For the definite diagnosis of PFD, defecography, colon transit time study, balloon expulsion testing, and anorectal manometry are needed. However, these methods are of high cost and cause discomfort to patients. Moreover, definite diagnosis cannot be made by a single test due to a high false positive rate. In general, several symptoms linked with problems in defecating, including excessive straining, the sensation of incomplete evacuation, and applying pressure around the anus or the vagina to facilitate defecation, are known to be frequently associated with PFD. The aim of this study was to evaluate whether specific clinical parameters could differentiate patients with PFD from other constipated patients. METHODS: An organized questionnaire including 47 questions that contained subjective symptoms, past medical history, and eating habits was designed. The questionnaire was distributed to 132 patients who fulfilled Rome II criteria for functional constipation. Digital rectal examination was conducted by a single gastroenterologist. RESULTS: Among 132 patients, 45 patients were categorized as PFD, 26 patients as slow transit constipation (STC) and 17 patients as normal transit constipation. Among specific questions about constipation, hard stool was more frequently noted in patients with STC than PFD (p<0.05), and the frequency of defecation was lower in patients with STC than PFD (p<0.05). However, the symptoms suggesting difficult defecation were not different between the two groups. The percentage of paradoxical contraction by digital rectal examination was not different between the two groups (PFD: 57.1% vs. STC: 48.0%). CONCLUSION: The symptoms and signs suggesting difficult defecation could not differentiate PFD from STC and normal transit constipation, although several parameters were different among the three subgroups. Therefore, anorectal physiologic tests are needed for the diagnosis of PFD.