Department of Gastroenterology-Hepatology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
Best Pract Res Clin Gastroenterol. 2011 Feb;25(1):159-66. doi: 10.1016/j.bpg.2011.01.004.
Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioural problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. Today, it is possible to diagnose this problem and treat this effectively with biofeedback therapy, history, prospective stool diaries, and anorectal physiological tests. Several randomised controlled trails have demonstrated that biofeedback therapy using neuromuscular training and visual and verbal feedback is not only efficacious but superior to other modalities such as laxative or sham training. Also the symptom improvement is due a change in the underlying pathophysiology. Development of user friendly approaches to biofeedback therapy and use of home biofeedback programs will significantly enhance the adoption of this treatment by gastroenterologists and colorectal surgeons in the future. Improved reimbursement for this proven and relatively inexpensive treatment will carry a significant impact on the problem.
协同性排便障碍很常见，影响多达一半的慢性便秘患者。这种后天获得的行为问题是由于无法协调腹部和盆底肌肉来排出粪便。如今，可以通过生物反馈疗法、病史、前瞻性粪便日记和肛肠生理测试来诊断这个问题，并有效地进行治疗。几项随机对照试验表明，使用神经肌肉训练和视觉及口头反馈的生物反馈疗法不仅有效，而且优于其他治疗方法，如泻药或假训练。此外，症状的改善是由于潜在病理生理学的改变。开发用户友好的生物反馈治疗方法和使用家庭生物反馈程序将显著提高胃肠病学家和结直肠外科医生在未来对这种治疗方法的采用。对这种经过验证且相对便宜的治疗方法的报销增加将对该问题产生重大影响。
