[Constipation. Proposal for a new classification and therapy].

Current approaches to constipation management often focus on symptom relief rather than addressing underlying functional causes. Prior research has shown that laxative dependence and irregular bowel patterns are common outcomes of chronic constipation. However, no prior work had resolved how non-pharmacological interventions might systematically address pelvic floor dysfunction. This gap motivated the development of a multidisciplinary rehabilitation protocol. The pelvic floor's role in bowel control is well established, but its targeted rehabilitation remains underexplored. Diagnostic tools such as clinical history and instrumental tests are standard, but their integration into a rehabilitation framework is novel. No prior work had resolved how combining physiotherapy with biofeedback could improve evacuation patterns. The distinction between functional and structural causes remains critical in treatment planning. This study aimed to bridge the knowledge gap between diagnostic accuracy and therapeutic outcomes.

The authors aimed to evaluate a multidisciplinary rehabilitation protocol for constipation by classifying patients based on symptom severity and pelvic floor function. This approach sought to move beyond laxative dependence by targeting pelvic floor dysfunction directly. The study's motivation stemmed from the lack of evidence-based rehabilitation strategies in constipation management. By integrating physiotherapy, electrostimulation, and biofeedback, the authors aimed to improve evacuation frequency and consistency. The protocol's structure included 15 weekly sessions followed by maintenance sessions every three months. This timeframe was chosen to assess both short-term and sustained therapeutic effects. The focus on pelvic floor rehabilitation reflects the anatomical basis of functional constipation. The study aimed to demonstrate that non-pharmacological interventions could yield long-term improvements.

The study involved 84 patients with constipation, selected based on clinical history and symptom severity. A diagnostic protocol included instrumental tests to assess pelvic floor function. Patients were classified according to the degree of constipation and symptomatology. The rehabilitation protocol combined three techniques: physiokinesitherapy, electrostimulation, and biofeedback. Each session lasted 60 minutes and occurred three times per week for 15 consecutive weeks. After this initial phase, patients received six maintenance sessions every three months. The study tracked changes in evacuation frequency, faecal consistency, and laxative use. Outcomes were assessed over a one-year period to evaluate long-term therapeutic success.

After one year, 77 patients (92%) achieved regular bowel activity with at least one evacuation per day. These patients also reported faecal consistency improvements and discontinued laxative use. The remaining seven patients (8%) reduced laxative dosage while improving evacuation frequency. No significant adverse effects were reported during the rehabilitation period. The protocol's success was measured by both frequency and consistency of bowel movements. Patients with pelvic floor dysfunction showed the most significant improvements. The maintenance sessions helped sustain gains achieved during the initial 15-week phase. The study demonstrated that non-pharmacological interventions could yield long-term benefits.

The authors propose that multidisciplinary rehabilitation can significantly improve constipation outcomes. Their findings suggest that combining physiotherapy, electrostimulation, and biofeedback is effective in managing pelvic floor dysfunction. The results indicate that non-pharmacological interventions may reduce laxative dependence. The study's one-year follow-up supports the sustainability of therapeutic gains. The authors emphasize the importance of classifying patients based on symptom severity and pelvic floor function. This approach may guide future treatment strategies for functional constipation. The findings suggest that rehabilitation protocols can offer an alternative to long-term pharmacological management. The study's results may inform clinical guidelines for constipation rehabilitation.