Department of Morphology, Surgery and Experimental Medicine, Section General Surgery, University of Ferrara, Ferrara, Italy.
Second Unit General Surgery, University Hospital Ferrara, Italy, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy.
Tech Coloproctol. 2021 May;25(5):589-595. doi: 10.1007/s10151-020-02381-9. Epub 2021 Feb 27.
Biofeedback is the most widespread rehabilitative therapy for the treatment of anismus after failed conservative treatment. Osteopathy represents an alternative therapy for constipation. The aim of this study was to evaluate short- and long-term results of osteopathic treatment as compared to biofeedback in patients with dyssynergic defecation.
This was a prospective cohort pilot study on 30 patients with dyssynergic defecation enrolled at the Colorectal Clinic of the University Hospital of Ferrara, Italy, from May 2015 to May 2016 and followed until May 2020. Dyssynergic defecation was defined as the inappropriate contraction of the pelvic floor or less than 20% relaxation of basal resting sphincter pressure (on anal manometry) with adequate propulsive forces during attempted defecation. Dyssynergic patients were divide into 2 treatment groups: 15 patients had osteopathy and 15 patients had biofeedback. Before and 3 months after rehabilitation treatment, all patients had anorectal manometry, defecography, and ultrasound, and were evaluated with the Cleveland Clinic Florida (CCF) constipation score, obstructed defecation syndrome (ODS) score, Colo-rectal-anal Distress Inventory (CRADI-8), Colo-rectal-anal Impact Questionnaire (CRAIQ-7), and the Brusciano Score (BS). To evaluate the efficacy of osteopathy and biofeedback in the long-term, all patients completed the above-mentioned questionnaires 5 years later via a telephone interview.
The two treatments were similarly effective in the short term with reduction in questionnaires scores, and increase in the percentage of anal sphincter release at straining at anorectal manometry in both groups. The ODS score was significantly reduced in biofeedback group (p = 0.021). The 3-month post-treatment BS was lower in the osteopathy group, but this just failed to reach statistical significance (p = 0.050). Periodic rehabilitation reinforcements were provided. The CCF constipation score decreased significantly in the osteopathy group (p = 0.023) after 5 years.
Osteopathy is a promising treatment for dyssynergic defecation, and it can be associated with biofeedback.
生物反馈是治疗保守治疗失败后的肛门失弛缓症的最广泛的康复治疗方法。整骨疗法代表了一种治疗便秘的替代疗法。本研究的目的是评估整骨治疗与生物反馈治疗在协同性排便障碍患者中的短期和长期结果。
这是一项前瞻性队列研究，纳入了 2015 年 5 月至 2016 年 5 月在意大利费拉拉大学医院肛肠诊所就诊的 30 名协同性排便障碍患者，并随访至 2020 年 5 月。协同性排便障碍定义为盆底不适当收缩或基础静息括约肌压力（肛门测压）低于 20%松弛，同时在排便尝试时推力不足。协同性排便障碍患者分为两组：15 例患者接受整骨治疗，15 例患者接受生物反馈治疗。在康复治疗前和治疗后 3 个月，所有患者均接受肛门直肠测压、排粪造影和超声检查，并采用克利夫兰诊所佛罗里达便秘评分（CCF）、阻塞性排便障碍综合征评分（ODS）、肛肠窘迫量表（CRADI-8）、肛肠影响问卷（CRAIQ-7）和布鲁西亚诺评分（BS）进行评估。为了评估长期整骨和生物反馈的疗效，所有患者在 5 年后通过电话访谈完成了上述问卷。
两组治疗在短期内均有效，问卷评分降低，两组患者在肛门直肠测压时肛门括约肌释放的比例增加。生物反馈组 ODS 评分显著降低（p=0.021）。整骨组治疗后 3 个月 BS 较低，但无统计学意义（p=0.050）。定期进行康复强化治疗。5 年后，整骨组 CCF 便秘评分显著降低（p=0.023）。
整骨治疗是协同性排便障碍的一种有前途的治疗方法，可与生物反馈联合应用。
