Obstructed defecation syndrome associated with paradoxical puborectalis contraction: osteopathic treatment versus anal biofeedback. Results of a pilot study

Ascanelli, Simona; Portinari, Mattia; Canella, Matteo; Solari, Stefano; Dall'Omo, F; Danese, Saverio; Troia, Alessandro De; Carcoforo, Paolo

doi:10.1007/s10151-020-02381-9

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Authors showed that their individuals reported improved overall constipation severity, symptoms and quality of life 28 . Another study with 13 children with cerebral palsy and chronic bowel constipation showed that osteopathic methods itself was as effective as osteopathic methods in addition to standard medical care 29 . Despite those studies were designed to be cross-sectional they were established with excellent methodological procedures.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Osteopathic Treatment in Bowel Constipation Patients: A Clinical Perspective

Pôrto,

Porto,

Filoni

et al. 2023

Rev. Cont. Saúde

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Introduction: Functional chronic bowel constipation is a motility disorder of great relevance and prevalence worldwide. Objective: Analyze the efficiency of visceral manipulation technique in individuals with bowel constipation diagnose according to Roma III criteria. Methods: This is a crossover clinical study that included individuals of both genders aged between 20 and 40 years who had had bowel constipation symptoms for over one year. Individuals were randomized into two groups: the intervention (IG) and control (CG) groups. A four weeks washout period was given. Each volunteer underwent 24 individual osteopathic sessions, twice a week that lasted up to 30 minutes. Three intervention techniques were performed: two for the large intestine and one for the small intestine. Results: Thirty four patients were recruited but nine were excluded. Our sample consisted in 25 participants, 13 were allocated in the IG and 12 in the CG. No significant difference was found between groups for anthropometric, educational, marital status, proportion of smokers and alcoholics, and VAS for lumbar spine pain measures. Lumbar spine flexibility, was significant increased for the IG (p<0.0001). A higher proportion of patients in the IG presented reduced hard stools, effort to evacuate, incomplete evacuation feeling, anorectal obstruction sensation and manual maneuvers to facilitate evacuation after treatment (p<0.0001). A significant correlation was found between pain (VAS) and the Schober test (r=-0.41). Conclusion: This study was successful in showing that there seems to be a positive effect of the osteopathic treatment for chronic bowel constipation at short and long terms.

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Section: Discussionmentioning

confidence: 99%

The Effectiveness of Osteopathic Treatment in Bowel Constipation Patients: A Clinical Perspective

Pôrto,

Porto,

Filoni

et al. 2023

Rev. Cont. Saúde

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“…In this study, we explored the diagnostic yield of DRE, while HRAM was considered as a reference standard for DD diagnosis. The paradoxical anal contraction was defined as an increase in anal pressure compared with the resting status when the patients were requested to defecate [ 15 , 16 ]. DD diagnosis by HRAM was based on the diagnostic criteria proposed by Soh et al [ 8 ], while standardized DRE was proposed by Tantiphlachiva et al [ 7 ].…”

Section: Diagnostic Studymentioning

confidence: 99%

Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis

Liu

Huang

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Background. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P < 0.001 ). Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. The outcomes demonstrated that the AUC was 0.85 (95% CI 0.82–0.88) with 77% summary sensitivity (95% CI 65–86) and 80% summary specificity (95% CI 71–86) to diagnose DD. Conclusions. DRE could be a valuable tool for screening DD. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. Meanwhile, our study highlights that DRE remains an important tool in clinical practice.

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“…Stool is expelled more easily through the relaxed anal sphincter as the anorectal angle widens. Defecation becomes impeded when the puborectalis muscle contracts paradoxically or fails to relax [13] . An ongoing inability to defecate can indirectly cause partial neurological malfunction, and an incorrect signal feedback loop can cause muscular spasms in the pelvic oor muscle or perhaps the entire muscle, creating a vicious cycle.…”

Section: Introductionmentioning

confidence: 99%

Spastic pelvic floor syndrome and puborectalis syndrome: The different stages of the same disease

Xiong,

Li,

Jiang

et al. 2024

Preprint

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The diagnosis and treatment of puborectalis syndrome (PRS) and spastic pelvic floor syndrome (SPFS) are still up for debate. This study aims to investigate examine the similarities and differences between PRS and SPFS. This study recruited 13 PRS cases, 10 SPFS cases, and 16 controls. Pelvic magnetic resonance imaging (MRI), histology, and ultrastructural pathology were explored. Additionally, anorectal manometry was performed prior to surgery, Wexner constipation scores and patient assessment of constipation quality of life (PAC-QOL) scores monitored before surgery, 6 and 12 m post-surgery. The puborectalis thickness in the pelvic MRIs of the SPFS and control groups did not appear to differ (4.62 ± 0.38 vs 4.56 ± 0.47, p = 0.378); however, the puborectalis in the PRS group was substantially thicker than that of the SPFS (8.65 ± 1.17 vs 4.62 ± 0.38, p < 0.001). The SPFS group showing atrophy and degeneration of muscle fibers and the PRS group exhibiting necrosis of muscle fibers, both groups had distorted texture myofibrils, disorganized arrangement, rough Z lines, however, in severe cases of PRS group, localized myofibrils fracture and myofilament dissolution presenting as vacuolation. Patients with normal preoperative rectal propulsion force had improvements in postoperative Wexner constipation scores and PAC-QOL scores. Histological and ultrastructural pathological evidence suggests that SPFS and PRS are distinct phases of paradoxical puborectalis syndrome (PPS). Furthermore, one indication for PPS surgical treatment is normal rectal evacuation pressure.

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Obstructed defecation syndrome associated with paradoxical puborectalis contraction: osteopathic treatment versus anal biofeedback. Results of a pilot study

Cited by 5 publications

References 15 publications

The Effectiveness of Osteopathic Treatment in Bowel Constipation Patients: A Clinical Perspective

The Effectiveness of Osteopathic Treatment in Bowel Constipation Patients: A Clinical Perspective

Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis

Spastic pelvic floor syndrome and puborectalis syndrome: The different stages of the same disease

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