Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Singapore Med J. 2012 Jun;53(6):381-4.
Constipation is a common affliction affecting the general population, with dyssynergic defaecation accounting for a large proportion of tertiary referrals. We sought to review the results of our patients with dyssynergic defaecation treated with biofeedback therapy in order to determine its efficacy.
All patients who were referred to the anorectal physiology laboratory of our tertiary unit for biofeedback therapy for dyssynergic defaecation were reviewed. Patients diagnosed with secondary constipation and slow-transit constipation were excluded. A defaecating proctogram was used to exclude anatomical abnormalities causing outlet obstruction. Patients underwent a four-session, structured biofeedback exercise programme under the supervision of trained nurses. The effectiveness of biofeedback treatment was assessed using the validated Eypasch's Gastrointestinal Quality of Life Index (GIQLI).
226 patients (85 male, 141 female; median age 48 years) underwent biofeedback treatment. Post treatment, improvement was observed in the overall total score of the GIQLI, with gastrointestinal symptom (68.6%), emotion (61.0%) and physical function (57.9%) components showing the most improvement. These improvements were also reflected in the mean scores of each component and the mean total score. All components, except for social function and medication, and the overall total score showed significant improvement post treatment. At the one-year follow-up, 160 (71%) patients reported that improvements were maintained.
Biofeedback is an effective treatment for patients with dyssynergic defaecation. Patients with chronic constipation not improved by fibre and laxatives should be referred to a tertiary centre with facilities for further anorectal physiological assessment.
便秘是一种常见的疾病，影响着普通人群，其中协同性排便障碍占三级转诊的很大一部分。我们旨在回顾接受生物反馈治疗的协同性排便障碍患者的结果，以确定其疗效。
回顾了所有因协同性排便障碍而被转诊到我们的三级单位进行生物反馈治疗的肛门直肠生理实验室的患者。排除了继发性便秘和慢传输性便秘的患者。使用排粪造影排除导致出口梗阻的解剖异常。患者在经过培训的护士的监督下接受了四个疗程的结构化生物反馈锻炼计划。使用经过验证的 Eypasch 胃肠道生活质量指数（GIQLI）评估生物反馈治疗的有效性。
226 名患者（85 名男性，141 名女性；中位年龄 48 岁）接受了生物反馈治疗。治疗后，GIQLI 的总体总分有所改善，胃肠道症状（68.6%）、情绪（61.0%）和身体功能（57.9%）方面的改善最为明显。这些改善也反映在每个组成部分的平均得分和总分上。除了社会功能和药物治疗外，所有组成部分和总体总分在治疗后均有显著改善。在一年的随访中，160 名（71%）患者报告改善得以维持。
生物反馈是治疗协同性排便障碍患者的有效方法。对于慢性便秘患者，如果纤维和泻药治疗无效，应转诊至有进一步肛门直肠生理评估设施的三级中心。
