Immediate results from biofeedback and anorectal electrostimulation in the treatment of paradoxical puborectal muscle contraction in women with obstructed defecation

Journal of Coloproctology - Tập 38 - Trang 42-49 - 2018
Germana Mesquita Magalhães1, Thiago Brasileiro de Vasconcelos2, Sthela Maria Murad Regadas3, Vasco Pinheiro Diógenes Bastos1, Paulo César de Almeida4, Lusmar Rodrigues Veras3
1Centro Universitário Estácio do Ceará, Fortaleza, CE, Brazil
2Centro Universitário Católica de Quixadá, Quixadá, CE, Brazil
3Universidade Federal do Ceará (UFC), Departamento de Cirurgia, Fortaleza, CE, Brazil
4Universidade Estadual do Ceará (UECE), Departamento de Saúde Pública, Fortaleza, CE, Brazil

Tóm tắt

AbstractObjective This study was conducted to evaluate the effects of “biofeedback” (BF), electrostimulation (ES), and of the high-fiber diet associated with behavioral therapy in women with obstructed evacuation and paradoxical puborectalis contraction and to compare the results among these three modalities.Method Thirty-one women were evaluated who fulfilled the Rome III Criteria, and with an electromanometric test positive for the presence of contraction in the evacuation maneuver. These patients were randomized into three groups: group I – conventional treatment of constipation, group II – conventional treatment of constipation associated with biofeedback and group III – conventional treatment of constipation associated with electrostimulation. At the beginning of this study and after six weeks, subjective and objective parameters of the anorectal function were evaluated using the Wexner constipation scoring system, the Bristol scale, an visual analogical scale, and anorectal electromanometry.Results All patients demonstrated improvement in bowel satisfaction, stool frequency, effort and feeling of incomplete evacuation, stool-type modifications, and improvement in the quality of life. On examination, there was increased mean pressure of voluntary contraction in group III (p = 0.043), decreased sensitivity threshold in group II (p = 0.025) and III (p = 0.012) and decreased maximum rectal capacity in group II (p = 0.005). Only 19.4% (n = 6) had their dynamic defecation normalized, and 80.6% (n = 25) expressed clinical, non-instrumental, improvement.Conclusion The conventional treatment of constipation, biofeedback and electrostimulation show a significant subjective improvement in symptoms of obstructed evacuation and in quality of life, regardless of the reversal of the paradoxical puborectalis contraction.

Tài liệu tham khảo

Drossman, 2006, The functional gastrointestinal disorders and the Rome III process, Gastroenterology, 130, 1377, 10.1053/j.gastro.2006.03.008 Locke, 2000, AGA medical position statement guidelines on constipation, Gastroenterology, 119, 1766, 10.1053/gast.2000.20392 Bharucha, 2013, American Gastroenterological Association technical review on constipation, Gastroenterology, 144, 218, 10.1053/j.gastro.2012.10.028 Agachan, 1996, Constipation scoring system to simplify evaluation and management of constipated patients, Dis Colon Rectum, 39, 681, 10.1007/BF02056950 Herbaut, 1994, Paradoxal contraction of pelvic floor muscles: clinical significance, Acta Gastroenterol Belg, 57, 13 Camilleri, 1999, Functional gastrointestinal disorders: novel insights and treatments, Medscape Gastro J, 1, 1 Pare, 2001, An epidemiological survey of constipation in Canada: definitions, rates, demographics and predictors of health care seeking, Am J Gastrenterol, 96, 3130, 10.1111/j.1572-0241.2001.05259.x Pucciani, 2003, Multimodal rehabilitation for faecal incontinence: experience of an Italian center devoted to faecal disorder rehabilitation, Tech Coloproctol, 7, 139, 10.1007/s10151-003-0025-5 Farid, 2009, Comparative study biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients, Int J Colorectal Dis, 24, 115, 10.1007/s00384-008-0567-0 Heymen, 2007, Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation, Dis Colon Rectum, 50, 428, 10.1007/s10350-006-0814-9 Peréz, 2009, The Bristol scale – a useful system to assess stool form?, Rev Esp Enferm Dig, 101, 305 Bastos, 2007, Dor Revista SBPH, 10, 87 Talley, 2004, Definitions, epidemiology, and impac to of chronic constipation, Rev Gastroenterol Disord, 4, 3 Tramonte, 1997, The treatment of chronic constipation in adults: a systematic review, J Gen Intern Med, 12, 15, 10.1007/s11606-006-0003-5 Rao, 2004, Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (anismus), Neurogastroenterol Motil, 16, 589, 10.1111/j.1365-2982.2004.00526.x Shouten, 1997, Anismus: fact or fiction, Dis Colon Rectum, 40, 1033, 10.1007/BF02050925 Rantis, 1997, Chronic constipation is the work-up worth the cost?, Dis Colon Rectum, 40, 280, 10.1007/BF02050416 Raza, 2009, Discriminative value of anorectal manometry in clinical practice, Dig Dis Sci, 54, 2503, 10.1007/s10620-008-0631-1 Mugie, 2011, Epidemiology of constipation in children and adults: a systematic review, Best Pract Res Clin Gastroenterol, 25, 3, 10.1016/j.bpg.2010.12.010 Longstreth, 2006, Functional bowel disorder, Gastroenterology, 130, 1480, 10.1053/j.gastro.2005.11.061 Ger, 1993, Anorectal manometry in the diagnosis of paradoxical puborectalis syndrome, Dis Colon Rectum, 36, 816, 10.1007/BF02047377 Regadas, 2006, Ecodefecografia tridimensional dinâmica. Nova técnica para avaliação da Síndrome da Defecação Obstruída (SDO), Rev Bras Coloproct, 26, 168, 10.1590/S0101-98802006000200008 César, 2008, Alterações das pressões anais em pacientes constipados por defecação obstruída, Rev Bras Coloproctol, 28, 402, 10.1590/S0101-98802008000400001 Laycock, 2003, The place of physiotherapy in the management of pelvic floor dysfunction, Obstet Gynaecol, 5, 194, 10.1576/toag.5.4.194.26931 Chiarioni, 2006, Biofeedback superior to laxatives for normal transit constipation due to pelvic floor dyssynergia, Gastroenterology, 131, 333, 10.1053/j.gastro.2006.05.031 Boselli, 2010, Biofeedback therapy plus anal electrostimulation for fecal incontinence: prognostic factors and effects on anorectal physiology, World J Surg, 34, 815, 10.1007/s00268-010-0392-9 Chang, 2003, Effect of electrical stimulation in constipated patients with impaired rectal sensation, Int J Colorectal Dis, 18, 433, 10.1007/s00384-003-0483-2 Snooks, 1985, Damage to the innervations of the pelvic floor musculature in chronic constipation, Gastroenterology, 89, 977, 10.1016/0016-5085(85)90196-9 Chang, 2004, Functional constipation with impaired rectal sensation improved by electrical stimulation therapy: report of a case, Dis Colon Rectum, 47, 933, 10.1007/s10350-004-0521-3 Gladman, 2006, Rectal hyposensitivity, Am J Gastroenterol, 101, 1140, 10.1111/j.1572-0241.2006.00604.x Gilliland, 1997, Outcome and predictors of success of biofeedback for constipation, Br J Surg, 84, 1123, 10.1002/bjs.1800840825 Rao, 2007, Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation, Clin Gastroenterol Hepatol, 5, 331, 10.1016/j.cgh.2006.12.023 Duthie, 1992, Animus: the cause of constipation? Results of investigation and treatment, World J Surg, 16, 831, 10.1007/BF02066978
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Journal of Coloproctology

Tập 38

42-49

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