Pelvic Floor Study in Patients With Obstructive Defecation

Abstract

The aim of this study was to evaluate the pathophysiologic abnormalities in patients with obstructive defecation or dyssynergia and to assess the role of biofeedback treatment. Three groups were studied. Group A had 24 patients with obstructive defecation; B, 25 patients with constipation; and C, 22 healthy volunteers. Rectosigmoid segmental transit time of group A was 28.5 hours (SD +/- 13.4); B, 17.2 hours (SD +/- 11.5); and C, 8.5 hours (SD +/- 6.3) (p < 0.05). There was no statistical difference in resting and squeezing anal pressure among the three groups. Anorectal angle at rest revealed no difference among the three groups. At strain, a statistically significant difference between groups A and C (p < 0.05) and a marginal difference between groups A and B was noted. Rectocele of the anterior rectal wall was present at strain in 17/24 patients of group A and 7/22 patients of group C (p < 0.05). Electromyography during strain revealed abnormal contractions of puborectalis muscle and external anal sphincter, in 13 and 14 patients of group A, respectively, which differed from that observed in groups B and C (p < 0.001). Biofeedback treatment was applied with good results in 7 of 11 patients of group A. At six months, constipation relapsed in only one of treated patients. Patients suffering from obstructive defecation seem to have slower rectosigmoid transit time than the others. Defecography shows smaller anorectal angle at strain and rectocele of the anterior rectal wall more often. Abnormal pelvic floor contraction at strain is often noted in anal electromyography. Some of these patients seem to respond favorably to biofeedback treatment.

Pelvic floor complaints in gastroenterology practice: results of a survey in the netherlands

“…Mounting literature has described the connection between PFD and faecal incontinence,12–14 constipation15 16 and IBS 17 18. However, our results show that gastroenterologists are not consistent in inquiring about pelvic floor complaints, although most of them seem to be aware of the integrated function of the pelvic floor.…”

Biofeedback Treatment of Constipation

“…In this study, Koutsomanis et al 33 compared perianal EMG biofeedback and balloon-defecation training to balloon-defecation training alone and found no significant difference between treatments in 60 subjects. The Koutsomanis et al 33 study also is one of the few investigations 20,26 to address the question of adequate propulsive force during attempts to defecate. In some cases, it may be that subjects are not pushing adequately to generate propulsive force on the rectum.…”

Successful Physical Therapy for Constipation Related to Puborectalis Dyssynergia Improves Symptom Severity and Quality of Life

“…4,5 Puborectalis dyssynergia is characterized by a paradoxic contraction of the puborectalis muscle and external anal sphincter, leading to the significantly impaired ability to expel stool during attempts to defecate. 6,7 The mainstay of therapy for puborectalis dyssynergia is physical therapy with biofeedback. 8,9 Improvements in defecation symptoms have been reported by 43 to 89 percent of patients in studies using nonvalidated measures of treatment success.…”