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Behavioural treatment (biofeedback) for constipation following hysterectomy
A J Roy1, A V Emmanuel, J B Storrie
1St Mark's Hospital, Northwick Park, Harrow HA1 3UJ, UK.
The British Journal of Surgery
|December 22, 1999
Summary
Constipation following hysterectomy often improves with behavioral treatment, similar to idiopathic constipation. This suggests reversible factors, not just nerve damage, play a key role in post-hysterectomy bowel issues.
Area of Science:
- Gastroenterology
- Gynecology
- Behavioral Medicine
Background:
- Constipation post-hysterectomy is often attributed to pelvic nerve damage.
- Emotional or reversible physical factors may also contribute to pathophysiological relevance.
Purpose of the Study:
- To determine if constipation after hysterectomy is responsive to behavioral treatment.
- To investigate the role of reversible factors versus nerve damage in post-hysterectomy constipation.
Main Methods:
- Compared three groups of patients receiving biofeedback treatment: no surgery history, hysterectomy with no bowel change, and hysterectomy-induced constipation.
- Assessed bowel function, symptoms, whole-gut transit time, and anorectal physiology pre- and post-treatment.
Main Results:
- 48 of 78 patients reported improvement with biofeedback, with similar proportions across groups.
- Biofeedback reduced straining, abdominal pain, and laxative use, and improved bowel frequency in all groups.
- Physiological testing did not predict treatment outcomes.
Conclusions:
- Most patients with hysterectomy-induced constipation experience subjective improvement with behavioral treatment.
- Reversible factors are likely significant contributors to symptoms, challenging the nerve damage theory.
- Behavioral interventions show efficacy for post-hysterectomy constipation, comparable to idiopathic cases.