Skardoon, GR;
Khera, AJ;
Emmanuel, AV;
Burgell, RE;
(2017)
Review article: dyssynergic defaecation and biofeedback therapy in the pathophysiology and management of functional constipation.
Alimentary Pharmacology and Therapeutics
, 46
(4)
pp. 410-423.
10.1111/apt.14174.
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Abstract
BACKGROUND: 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. AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
| Type: | Article |
|---|---|
| Title: | Review article: dyssynergic defaecation and biofeedback therapy in the pathophysiology and management of functional constipation |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/apt.14174 |
| Publisher version: | http://dx.doi.org/10.1111/apt.14174 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Gastroenterology & Hepatology, Pharmacology & Pharmacy, Pelvic Floor Dyssynergia, Resolution Anorectal Manometry, Randomized Controlled-Trial, Slow Transit Constipation, Transanal Rectal Resection, Balloon Evacuation Test, Fecal Incontinence, Behavioral Treatment, Puborectalis Muscle, Botulinum Toxin |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1565064 |
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