Severe Postoperative Chronic Constipation Related to Anorectal Malformation Managed with Osteopathic Manipulative Treatment

Abstract

Constipation is frequent amongst infants who have undergone surgery for anorectal malformation (ARM). Faecal retention, due to a dysfunctional enteric reflex of defaecation, can cause abdominal cramps, pseudoincontinence and, in the worst cases, megacolon. Prokinetic protocols are used to stimulate at least 1 bowel movement per day, including laxatives, enema, stools softeners and dietary schedules. While osteopathic manipulative treatment is adopted in adults for functional constipation, it has not been described for infants. Herein, we report the case of an infant undergoing anorectoplasty for a low ARM who was referred to the osteopath 2 years after the onset of severe constipation associated with pseudoincontinence and abdominal cramps and was refractory to the prokinetic protocol. In a child with a good ARM prognosis, autonomous daily bowel movements should be achieved. In this child, the imbalanced tension of the pelvic floor and immaturity of the parasympathetic plexus led to a Case

Neurogenic Bowel Dysfunction Changes after Osteopathic Care in Individuals with Spinal Cord Injuries: A Preliminary Randomized Controlled Trial

“…These elements favor the onset of extremely prolonged intestinal transit and, decreased colon motility that result in frequent manifestations of abdominal distension, constipation accompanied by symptoms such as bloating, pain and abdominal constipation [ 38 ]. The starting hypothesis of the study was based on the assumption that OMT may influence the central nervous system [ 20 , 21 ], autonomic nervous system [ 14 ], haemodynamic system [ 14 ] and visceral motility [ 23 ] as reported in previous clinical studies [ 22 , 23 , 24 , 25 ].…”

“…The treatment of SDs using different osteopathic techniques can promote neurophysiological changes that presumably influence the neurovegetative system as reported in previous studies [ 14 , 20 , 21 ]. OMT effects on the gastrointestinal system were already investigated in different populations: women with constipation [ 22 ], people who suffer from Irritable Bowel Syndrome [ 23 ], children with anorectal malformation [ 24 ] and neurodevelopmental disorder [ 25 ]. These studies suggested OMT influence on visceral vascularization, physiological elasticity and visceral motility [ 23 ], and reported improvements in stool consistency, symptoms of constipation, the severity of constipation, and in reducing the use of laxative drugs.…”

Osteopathic Manipulative Treatment During Post-operative Recovery: A Scoping Review

“…In the field of general surgery, nine studies were found that evaluated the impact of OMT in post-operative patients. Three studies were case reports [16,31,34], two were case series [5,14], two were RCTs [22,29], one was a cohort study [11], and one was a qualitative study [28]. While a range of OMT techniques were used across all of the studies, some of the most common were MFR, ME, and cranial manipulation [5,11,14,16,22,29,31,34].…”

“…Three studies were case reports [16,31,34], two were case series [5,14], two were RCTs [22,29], one was a cohort study [11], and one was a qualitative study [28]. While a range of OMT techniques were used across all of the studies, some of the most common were MFR, ME, and cranial manipulation [5,11,14,16,22,29,31,34]. Three of the studies involved post-op ileus [11,14,16], three involved GI resections [11,29,31], and four involved laparoscopic procedures [5,16,22,29].…”

“…A variety of different body systems and surgical techniques have been researched including musculoskeletal, cardiac, pulmonary, oncologic, and more [1,5,. These studies have demonstrated decreased symptoms at viscerosomatic levels of treatment [19,25], improved lymphatic circulation [37], improved cardiac function and perfusion [26], decreased length of hospital stay [11,14,29,35], decreased pain [20,21,24,28,29,31,32,34,36,38], decreased pain medication use [1,22,28,39] and decreased morbidity [29].…”