Biofeedback, biofeedback plus fiber laxative, and biofeedback plus osmotic laxative regimens to treat constipation in patients with pelvic floor dyssynergia: A randomized controlled trial.

BACKGROUND: Pelvic floor dyssynergia (PFD) is one of the causes of chronic constipation. Laxative-based therapies are not very effective in treating this type of constipation. The therapeutic effectiveness of three therapeutic strategies, including biofeedback (BOF) alone, BOF+ fiber laxative (psyllium), and BOF +osmotic laxative (polyethylene glycol; [PEG]), was assessed in patients with constipation secondary to PFD. METHODS: Eighty-eight patients with constipation were included during a period from 2017 to 2018. Thirty-two patients were treated with BOF alone, 25 patients received BOF+ fiber laxative (psyllium), and 31 patients received BOF+ osmotic laxative (PEG) for 2 to 3 months. A checklist was used to compare outcomes before and after the interventions. RESULTS: Satisfaction rates from the treatments were 60.83%, 46.88%, and 41.32% in the BOF, BOF + psyllium, and BOF + PEG groups, respectively. Women had a higher satisfaction rate compared to men. Defecation quality improved, and the frequency of enema usage decreased (p <0.05) in all the groups after intervention. Difficulty in evacuation, need for digitation, and return to the toilet after defecation significantly improved in the BOF alone group. Using laxatives reduced straining during evacuation and increased the duration of defecation. All the three regimens reduced rectal bleeding (p <0.05). CONCLUSIONS: Combinations of laxatives with BOF did not offer significant therapeutic benefit. As laxatives may cause dissatisfaction and incomplete/prolonged defecations in patients with PFD, adding laxatives to the BOF regimen is not recommended for these patients.

Comparing the Pattern of Menopausal Symptoms, Concern and Attitudes in Urban and Rural Postmenopausal Iranian Women.

OBJECTIVES: Although hormonal changes during menopause are inevitable in this period, the severity of the menopausal symptoms can be controlled. Accepting menopause and having a positive attitude toward it can also help. Given the results of previous studies, and since environmental factors affect the pattern of menopausal symptoms the present study was conducted to compare the pattern of menopausal symptoms, concern and attitudes in urban and rural postmenopausal women. METHODS: This cross-sectional study was conducted on urban and rural postmenopausal women residing in and around Tabriz, Iran. Cluster sampling was used to select the subjects. The data collection tools used included a demographic questionnaire to assess women's experiences during menopause. RESULTS: This study examined 544 urban and rural postmenopausal women between March and September 2015. The women had a mean age of 51.8 ± 3.1. After adjusting the basic variables, the mean scores of menopausal symptoms and their subscales showed significantly higher scores in the physical and psychological subscales in the urban women, while the rural women had significantly higher scores in the concern subscale. CONCLUSIONS: Rural women were significantly different from urban women in terms of menopausal symptoms, concern and attitudes. Hot flushes, a common menopausal symptom, and decreased sexual desire were more common in the urban women; in contrast, the rural women experienced more concern about menopause and its consequences.

The effect of prebiotic vaginal gel with adjuvant oral metronidazole tablets on treatment and recurrence of bacterial vaginosis: a triple-blind randomized controlled study.

PURPOSE: Bacterial vaginosis is a change in the normal vaginal bacterial flora that leads to loss of hydrogen peroxide producing lactobacilli and overgrowth of predominantly anaerobic bacteria. The present study was conducted to compare the effects of prebiotic vaginal gel with oral metronidazole tablet and metronidazole tablet alone on treatment and recurrence of bacterial vaginosis. METHODS: The present triple-blind randomized clinical trial was conducted in Sadatmandi Hospital in Robat-Karim town, where 100 patients were randomly divided into intervention (receiving a 5 mg prebiotic vaginal gel applicator plus three 250 mg metronidazole tablets per day for 7 days) and control (receiving a 5 mg placebo vaginal gel applicator and three 250 mg metronidazole tablets per day for 7 days) groups. Then, patients were assessed for bacterial vaginosis on 90 ± 3 day after treatment. Data collected were analyzed in SPSS-21 using Chi square, repeated measures, and student's t tests at a significance level of P < 0.05. RESULTS: The results obtained showed no significant difference between the two groups in terms of personal and social characteristics, clinical complaints, or laboratory markers. On the 10th day, healing rate based on Amsel and Nugent criteria was 76% in the intervention group and 30% in the control group [odds ratio (OR) 4.3; 95% confidence interval (CI) 2.7-9.4]. On the 90th day, healing rate was 84% in the intervention group and 62% in the control group (OR 3.7; 95% CI 1.3-8.9). CONCLUSIONS: Adjuvant treatment with prebiotic vaginal gel improves the efficacy of bacterial vaginosis treatment.