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Obstructive defecation: a failure of rectoanal coordination
S S Rao1, K D Welcher, J S Leistikow
1Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.
The American Journal of Gastroenterology
|July 22, 1998
Summary
Obstructive defecation is caused by impaired rectoanal coordination. Biofeedback therapy effectively corrected these issues and improved constipation symptoms in patients.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Physiology
Background:
- The underlying causes of obstructive defecation remain poorly understood.
- Rectoanal coordination plays a crucial role in the defecation process.
Purpose of the Study:
- To investigate if impaired rectoanal coordination is a cause of obstructive defecation.
- To determine if biofeedback therapy can correct this dysfunction.
Main Methods:
- Prospective study involving 35 patients with chronic constipation and 25 healthy controls.
- Anorectal manometry and balloon expulsion test were used to assess defecation dynamics.
- Biofeedback therapy was offered to patients with obstructive defecation, with reassessment post-treatment.
Main Results:
- Eighteen patients exhibited obstructive defecation, characterized by lower intrarectal pressure and defecation index, and higher anal residual pressure.
- Biofeedback therapy significantly improved intrarectal pressure, defecation index, and reduced anal residual pressure.
- Patients reported improved stool frequency, reduced straining, increased bowel satisfaction, and decreased reliance on laxatives.
Conclusions:
- Obstructive defecation is associated with impaired rectal contraction, paradoxical anal contraction, or inadequate anal relaxation, indicating disturbed rectoanal coordination.
- Biofeedback therapy proved effective in rectifying these pathophysiological abnormalities.
- The study highlights biofeedback as a viable treatment for improving constipation due to obstructive defecation.