Ameliorating Effects of Transcutaneous Electrical Acustimulation at Neiguan (PC6) and Zusanli (ST36) Acupoints Combined with Adaptive Biofeedback Training on Functional Outlet Obstruction Constipation

Abstract

Background. Stimulant laxatives are still considered the most common treatment for functional outlet obstruction constipation (FOOC). However, the effectiveness of laxatives is unsatisfactory, and the long-term use of laxatives may cause certain adverse events. With this in mind, it is, however, paramount that novel complementary treatment(s) and/or other forms of alternative medicine are adequately investigated. Aims. The study aims to explore the effects and potential mechanism(s) of transcutaneous electrical acustimulation (TEA) combined with adaptive biofeedback training (ABT) on FOOC. Methods. A total of forty-five patients with FOOC were recruited and were randomly assigned to receive either Macrogol 4000 Powder (MAC, 10 g bid) (group A, n = 15) only, ABT + MAC + Sham-TEA (group B, n = 15), or TEA + ABT + MAC (group C, n = 15) in a six-week study. Individual patients' constipation-symptoms (PAC-SYM) and constipation-quality of life (PAC-QOL) were both assessed and scored. Serum acetylcholine (Ach) and nitric oxide (NO) were measured from drawn blood samples while individual patients' heart rate variability (HRV) was calculated at baseline and after each corresponding therapy. Anorectal manometry and balloon expulsion test were both performed before and after treatment. Results. Firstly, participants in group C had significantly lower scores of PAC-SYM, PAC-QOL, and a decreased anal defecating pressure (ADP) as compared to participants in group B (all p<0.050). These results, however, suggest the TEAs effect. Secondly, the low-frequency band (LF)/(LF + HF) ratio in groups B and C were decreased as compared to group A (p=0.037, p=0.010, respectively) regarding HRV. On the other hand, the high-frequency band (HF)/(LF + HF) ratio in groups B and C showed an opposite outcome. Finally, the serum Ach in groups B and C was significantly higher as compared to group A (p=0.023, p=0.012, respectively). Of significant importance, the serum NO in groups B and C were notably low as compared to group A (p=0.001, p<0.001, respectively). Conclusions. TEA, combined with ABT, effectively improves constipation symptoms as well as QOL in FOOC patients. It is, however, achieved by decreasing ADP, which mechanisms are mediated via the autonomic and enteric mechanisms.

Sleep Deficiency Is Associated With Exacerbation of Symptoms and Impairment of Anorectal and Autonomic Functions in Patients With Functional Constipation

“…Of note, Liu et al (2018) documented that an escalation in sympathetic nerve activity is associated with constipation. Meanwhile, our previous study showed that the imbalance between sympathetic and parasympathetic nerves plays a vital role in constipation symptoms ( Liu et al, 2020 ). Notably, the current study showed that sleep disorders will influence the balance between parasympathetic and sympathetic nerves thus remarkably increasing sympathetic activities, which is similar outcomes to previous research ( Carter et al, 2018 ; Wang S. et al, 2019 ).…”

“…All FC patients underwent HRAM (MedKinetic, Ningbo, China), and the process of HRAM was described in our previous research ( Liu et al, 2020 ). Each patient received 1–2 doses of glycerin enema for bowel preparation 30–60 min prior to the HRAM test.…”

Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis

“…HRAM and balloon expulsion test (BET) are recommended as the first modalities to evaluate these patients. The principal objective of performing physiologic tests for constipated patients is to identify those with DD, as these patients would respond well to biofeedback therapy [ 13 , 28 ]. In short, the results of anorectal physiologic tests were directly associated with subsequent treatment choices for constipated patients.…”

“…All participants underwent a HRAM test (Med Kinetic, Ningbo, China), and the results were recorded by a single experienced investigator (J L), as described in our previous research [ 13 ]. An anorectal catheter was inserted in each patient's rectum, and anal resting pressure (ARP) was measured using a water-perfused anorectal manometric catheter equipped with eight pressure sensors at 1 cm interval.…”

Sustained ameliorating effects and autonomic mechanisms of transcutaneous electrical acustimulation at ST36 in patients with chronic constipation

“… Wu et al (2020) designed a cross-over study to compare the effectiveness of TEA at ST36 and TEA at PTN in treating functional constipation and found that TEA was more potent at ST36 than at PTN in improving constipation and the constipation-related symptoms. Liu et al (2020) reported the ameliorating effects of TEA at the Neiguan (PC6) and ST36 acupoints combined with adaptive biofeedback training in patients with functional outlet obstruction constipation. However, these studies were all conducted in a single center and lacked comprehensive analysis of constipation symptoms and rectal sensation.…”