Skardoon G R, Khera A J, Emmanuel A V, Burgell R E
Alfred Health, Melbourne, Vic., Australia.
Alfred Health Continence Clinic, Caulfield, Vic., Australia.
Aliment Pharmacol Ther. 2017 Aug;46(4):410-423. doi: 10.1111/apt.14174. Epub 2017 Jun 29.
Functional constipation is a common clinical presentation in primary care. Functional defaecation disorders are defined as the paradoxical contraction or inadequate relaxation of the pelvic floor muscles during attempted defaecation (dyssynergic defaecation) and/or inadequate propulsive forces during attempted defaecation. Prompt diagnosis and management of dyssynergic defaecation is hindered by uncertainty regarding nomenclature, diagnostic criteria, pathophysiology and efficacy of management options such as biofeedback therapy.
To review the evidence pertaining to the pathophysiology of functional defaecation disorders and the efficacy of biofeedback therapy in the management of patients with dyssynergic defaecation and functional constipation.
Relevant articles addressing functional defaecation disorders and the efficacy of biofeedback therapy in the management of dyssynergic defaecation and functional constipation were identified from a search of Pubmed, MEDLINE Ovid and the Cochrane Library.
The prevalence of dyssynergic defaecation in patients investigated for chronic constipation is as many as 40%. Randomised controlled trials have demonstrated major symptom improvement in 70%-80% of patients undergoing biofeedback therapy for chronic constipation resistant to standard medical therapy and have determined it to be superior to polyethylene glycol laxatives, diazepam or sham therapy. Long-term studies have shown 55%-82% of patients maintain symptom improvement.
Dyssynergic defaecation is a common clinical condition in patients with chronic constipation not responding to conservative management. Biofeedback therapy appears to be a safe, successful treatment with sustained results for patients with dyssynergic defaecation. Further studies are required to standardise the diagnosis of dyssynergic defaecation in addition to employing systematic protocols for biofeedback therapy.
功能性便秘是基层医疗中常见的临床表现。功能性排便障碍被定义为在试图排便时盆底肌肉出现矛盾性收缩或松弛不足（排便协同失调）和/或在试图排便时推进力不足。由于命名、诊断标准、病理生理学以及生物反馈疗法等治疗选择的疗效存在不确定性，排便协同失调的及时诊断和管理受到阻碍。
综述与功能性排便障碍的病理生理学以及生物反馈疗法在治疗排便协同失调和功能性便秘患者中的疗效相关的证据。
通过检索PubMed、MEDLINE Ovid和考克兰图书馆，确定了有关功能性排便障碍以及生物反馈疗法在治疗排便协同失调和功能性便秘中的疗效的相关文章。
在接受慢性便秘调查的患者中，排便协同失调的患病率高达40%。随机对照试验表明，70%-80%接受生物反馈疗法治疗对标准药物治疗无效的慢性便秘患者的主要症状得到改善，并确定其优于聚乙二醇泻药、地西泮或假治疗。长期研究表明，55%-82%的患者症状持续改善。
排便协同失调是慢性便秘患者中常见的临床情况，对保守治疗无反应。生物反馈疗法似乎是一种安全、成功的治疗方法，对排便协同失调患者有持续效果。除了采用生物反馈疗法的系统方案外，还需要进一步研究以规范排便协同失调的诊断。
