Advances in the diagnosis and treatment of spastic pelvic floor syndrome / 中国综合临床

Objective Spastic pelvic floor syndrome (SPFS) is a common chronic functional constipation characterized by irregular defecation,low defecation frequency,difficult defecation,and discomfort and pain in the anus and perineum.The pathophysiologic mechanism of the disease has not yet been clearly understood,so there is no targeted treatment.At present,biofeedback therapy is an effective,safe and non-invasive method for the treatment of spastic pelvic floor syndrome,which is often combined with Chinese medicine and psychological intervention in clinical treatment.

Clinical Observation of Electroacupuncture for Spastic Pelvic Floor Syndrome / 上海针灸杂志

Objective To compare the treatment efficacy and improvement of relevant indexes between electroacupuncture and biofeedback therapy in treating spastic pelvic floor syndrome (SPFS).Method Fifty SPFS patients were randomized into an electroacupuncture group and a biofeedback group by their visiting sequence, 25 cases each. In the electroacupuncture group, Baliao [Shangliao (BL31), Ciliao (BL32), Zhongliao (BL33), and Xialiao (BL34)], Zhigou (TE6), Dachangshu (BL25), Shangjuxu (ST37), Xiajuxu (ST39) and Tianshu (ST25) were selected and connected to HANS electroacupuncture apparatus, at 2 Hz and withinthe tolerable intensity, 30 min for each session. The treatment was given once every day, 6 sessions as a treatment course, with 1-day interval between two courses, for 4 courses in total. The biofeedback group was intervened by biofeedback therapy under doctor's guidance to correct the wrong defecation behavior. The treatment was given once every other day, 6 sessions as a treatment course, for 4 weeks in total. At the end of intervention, the therapeutic efficacy was evaluated, the anorectal angulation was measured by defecography (DFG), and the resting and contracting anorectal pressures were determined by anorectal manometry. Result There was no significant difference in comparing the therapeutic efficacy between the electroacupuncture group and biofeedback group(P>0.05). The anorectal angulation and pressure were improved in the two groups(P<0.05), and the improvement in the electroacupuncture group was more significant(P<0.05).Conclusion Electroacupuncture can effectively treat SPFS, equivalent to the popularly used biofeedback therapy, while electroacupuncture can produce a more significant effect in improving the anorectal angulation and pressure.

The effect of sacral nerve stimulation (SNS) on spastic pelvic floor syndrome / 中华普通外科杂志

Objective To evaluate sacral nerve stimulation (SNS) in the treatment of spastic pelvic floor syndrome (SPFS).Method In this study,36 patients of spastic pelvic floor syndrome who received SNS treatment from 2011.3 to 2011.12,were reviewed in terms of clinical curative effect,changes of anal pressure and defecography.Result After a course of SNS treatment,patients were followed up for 3 months,12 cases were cured,22 cases improved and 2 cases were ineffective,the total effective rate was 94.4％.The symptoms such as endless defecate feeling,difficulty in defecation,anal pain and anal obstruction feeling improved significantly (P ＜0.01 ).After the therapy,rectal anal reflex( RAR)threshold value volume rose,anal maximum contraction pressure (AMCP),anal rest perssure (ARP) decreased (P ＜ 0.01 ).While the anal longest contraction time (ALCT)and rectal rest pressure (RRP) did not change significantly (P ＞ 0.05 ).After treatment,when patient defecate the anorectal angle (ARA) increases,the puborectal muscle spasm notch (PMSN)attenuates (P ＜ 0.01 ).Conclusions SNS is effective and minimally invasive in treating spastic pelvic floor syndrome.

Dor posterior baixa e dor pélvica: o que interessa ao proctologista? / Lower back and pelvic pain: what does concern to the proctologist?

Um do mais intrigante e frequente sintoma de doenças agudas ou crônicas é a dor, sobretudo quando aparece sem um substrato anatomo-patológico facilmente identificável, o que dificulta o tratamento e favorece sua persistência. A dor crônica, generalizada ou localizada, transtorna a vida da pessoa, cuja qualidade é significativamente afetada na proporção da intensidade e continuidade da dor. A dor pélvica e a dor posterior baixa são sintomas relativamente comuns, principalmente por estarem relacionados etiologicamente com mais de uma centena de doenças - desde as que são de origem infecciosa até as inflamatórias inespecíficas, passando pelas que são decorrentes de alterações osteomusculares carências ou funcionais, até às neoplásicas eàs de causas indeterminadas. Além disso, há fatores estruturais sobrecarregados pelos atuais estilos de vida, não só em relaçãoà postura física, como permanecer sentado por longo período de tempo, mas também por falta de exercícios que deveriam ser praticados como preparo para o cotidiano. Soma-se, ainda, a estimativa de que 60 por cento das pessoas estão na faixa do sobrepeso e 25 por cento são obesas. Pela frequência de aparecimento e por sua relação com os órgãos pélvicos, a dor pélvica e a dor posterior baixa, cuja investigação pode envolver profissionais de várias áreas, devem ser do obrigatório interesse do médico coloproctologista.

Pain is one the most intriguing and frequent symptom of diseases, above all when it appears without an easily identifiable anatomic pathological substratum. Widespread or located chronic pain upsets the person's life whose quality is significantly affected. Chronic pelvic pain syndrome is a conundrum that may be only partly explained; it is relatively common and etiologically related with more than a hundred diseases (infectious and/or inflammatory) perceived in structures related to the pelvis. "Add to that a general lack of exercise, poor diet, and an overall increase in peoples' weight. With 61 percent of the population overweight (and 27 percent of that group diagnosed as clinically obese), it should be no surprise that this degree of increased weight causes more stress and strain on the pelvis and those articulations that we use when standing, walking, and running.1 Patients also expose themselves to a variety of traumas that often do not heal properly, leading to osteoarthritis, fibrotic joint capsules, and myofascial trigger points."13 For the emergence frequency and for its relationship with the pelvic organs, the pelvic pain and the low back pain can be considered a multifaceted problem, with investigation requiring a multidisciplinary approach involving professionals of several areas, so they should be of the obligatory interest of the proctologist.