“…Bio feedback therapy is morbidity free effective therapy for well motivated patients diagnosed of having this condition. Gadel Hak et al reported 91.6% subjectively overall improvement of symptoms in a group of 60 patients who underwent biofeedback therapy [5]. Although it has been shown to have limited therapeutic effect in clinical practice [6] botulinum toxin injection is useful in relieving symptoms in the short term which causes transient relaxation of puborectalis sling allowing confirmation of the diagnosis.…”
“…Bio feedback therapy is morbidity free effective therapy for well motivated patients diagnosed of having this condition. Gadel Hak et al reported 91.6% subjectively overall improvement of symptoms in a group of 60 patients who underwent biofeedback therapy [5]. Although it has been shown to have limited therapeutic effect in clinical practice [6] botulinum toxin injection is useful in relieving symptoms in the short term which causes transient relaxation of puborectalis sling allowing confirmation of the diagnosis.…”
“…Anal manometry assessment was done (Fig. 4 ) [ 1 , 13 ]. Pelvic floor electrophysiological studies were conducted to assess the pudendal nerve terminal motor latency and electromyography for the external anal sphincter (EAS) and puborectalis (PR) muscles to verify the presence of anismus as a diagnosis of functional OD [ 26 , 27 ].…”
Section: Methodsmentioning
confidence: 99%
“… Fig. 4 Illustration shows different aspects of assessment of functional obstructed defecation [ 1 , 13 , 15 , 24 – 27 ] …”
Section: Methodsmentioning
confidence: 99%
“…The technique of pressure-based BF training is demonstrated in Fig. 5 [ 13 , 16 , 29 ]. The technique of transcutaneous PTNS is demonstrated in Fig.…”
Section: Methodsmentioning
confidence: 99%
“…It is very effective for patients suffer of functional OD [ 11 ]. It is the initial therapy for functional OD after failure of dietary modification, life style modification, and laxatives [ 12 , 13 ]. If BF training failed to improve the condition, PTNS was applied as a sort of peripheral neuromodulation [ 14 , 15 ].…”
Background
Functional obstructed defecation is a common anorectal problem among adult population. The objective was to compare the short-term efficacy of biofeedback pelvic floor muscle training versus transcutaneous posterior tibial nerve electrostimulation in treatment of patients with functional obstructed defecation.
Results
There were 41 patients completed the study. There were no statistical significant differences between biofeedback pelvic floor muscle training group and transcutaneous posterior tibial nerve electrostimulation group regarding different clinical characteristics, as well as, electrophysiological findings. There was statistically significant reduction in all outcome measures after intervention in both groups. The primary outcome measure was Modified obstructed defecation score. Secondary outcome measures were Patient Assessment of Constipation-Quality of Life questionnaire, time of toileting, and maximum anal pressure during straining to evacuate. No significant differences were present between both groups regarding different outcome measures in the pretreatment and post-treatment assessments. Successful outcome was reported in 81% of patients in biofeedback pelvic floor muscle training group in comparison to 40% of patients in the posterior tibial nerve electrostimulation group according to the Modified obstructed defecation score which was the primary outcome measure.
Conclusions
Both biofeedback pelvic floor muscle training and posterior tibial nerve electrostimulation are considered effective methods in the treatment of functional obstructed defecation. However, biofeedback pelvic floor muscle training seems to be more effective and superior in comparison to posterior tibial nerve electrostimulation. Posterior tibial nerve electrostimulation could be combined with biofeedback pelvic floor muscle training or considered as a second line therapy after failure of biofeedback pelvic floor muscle training.
Trial registration
Pan African Clinical Trials Registry, PACTR202009762113535. Registered 2 September 2020—retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12321.
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