Türkiye Yüksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey.
Ankara Yildirim Beyazit University Department of Biostatistics.
Acta Gastroenterol Belg. 2021 Oct-Dec;84(4):577-583. doi: 10.51821/84.4.008.
It is now known that with appropriate exercises, the functions of the muscles in the body ameliorate and increase in strength. We applied pelvic floor muscle relaxation training and exercises that strengthen the abdominal and pelvic muscles in combination with biofeedback therapy (BFT) to patients with dyssynergic defecation (DD).
Patients who met the criteria for DD and had no underlying organic cause were included in this study. The electromyography (EMG) technique was used for BFT therapy. Patients had received at least six sessions of BFT. BFT was considered successful in patients when the DD pattern in anorectal manometry (ARM) disappeared and/or adequate anal relaxation was obtained following BFT and in patients who had full clinical recovery.
Data of 104 patients (58 females [55.8%] and 46 males [44.2%]) was evaluated. Abdominal and rectal symptoms disappeared in 71 (68.26%) patients. Of the patients who achieved symptomatic improvement, 58 (55.76%) saw a disappearance of the dyssynergic defecation pattern. When the differences between anal sphincter pressures before and after treatment were compared in patients who responded to BFT and those who did not, no significant differences were observed, but significant changes were found in anal squeezing pressures. It was found that those who had high squeezing pressures before BFT, those who increased their squeezing pressures after BFT, and those who decreased their resting pressure responded better to BFT.
In this study, BFT was found to be more effective in those with a high squeezing pressure and those that increased squeezing pressure after BFT. These findings will influence the treatment of patients with dyssynergic defecation who do not respond to treatment. A combination of abdominal and pelvic floor muscle exercises and BFT increases patient response.
现在已知，通过适当的锻炼，身体肌肉的功能会得到改善并增强力量。我们将盆底肌肉放松训练和加强腹部及骨盆肌肉的运动与生物反馈治疗（BFT）相结合，应用于协同性排便障碍（DD）患者。
本研究纳入符合 DD 标准且无潜在器质性病因的患者。采用肌电图（EMG）技术进行 BFT 治疗。患者至少接受了 6 次 BFT。当肛管直肠测压（ARM）中的 DD 模式消失，并且/或 BFT 后获得足够的肛门松弛，或者患者完全临床康复时，BFT 被认为是成功的。
共评估了 104 例患者（58 例女性[55.8%]和 46 例男性[44.2%]）的数据。71 例（68.26%）患者的腹部和直肠症状消失。在症状改善的患者中，58 例（55.76%）DD 模式消失。在对 BFT 有反应和无反应的患者之间比较治疗前后肛门括约肌压力的差异时，未观察到显著差异，但在肛门挤压压力方面发现了显著变化。结果发现，那些 BFT 前挤压压力较高的患者、BFT 后挤压压力增加的患者以及休息压力降低的患者对 BFT 的反应更好。
在本研究中，BFT 对挤压压力较高和 BFT 后挤压压力增加的患者更有效。这些发现将影响对治疗无反应的协同性排便障碍患者的治疗。腹部和盆底肌肉运动与 BFT 的结合增加了患者的反应。
