Pelvic floor study in patients with obstructive defecation - Influence of biofeedback

The aim of this study was to evaluate the pathophysiologic abnormalities in patients with obstructive defecation or dyssynergia and to assess the role of biofeedback treatment. Three groups were studied. Group A had 24 patien ts with obstructive defecation; B, 25 patients with constipation; and C, 22 healthy volunteers. Rectosigmoid segmental transit time of group A was 28. 5 hours (SD +/-: 13.4); B, 17.2 hours (SD +/- 11.5); and 28.5 hours (SD +/- 6.3) (p < 0.05). There was no statistical difference in resting and squeez ing anal pressure among the three groups. Anorectal angle at rest revealed no difference among the three groups. At strain, a statistically significan t difference between groups A and C (p < 0.05) and a marginal difference be tween groups A and B was noted. Rectocele of the anterior rectal wall was p resent at strain in 17/24 patients of group A and 7/22 patients of group C (p < 0.05). Electromyography during strain revealed abnormal contractions o f puborectalis muscle and external anal sphincter, in 13 and 14 patients of group A, respectively, which differed from that observed in groups B and C (p < 0.001). Biofeedback treatment was applied with good results in 7 of 1 1 patients of group A. At six months, constipation relapsed in only one of treated patients. Patients sufferings from obstructive defecation seem to h ave slower rectosigmoid transit time than the others. Defecography shows sm aller anorectal angle at strain and rectocele of the anterior rectal wall m ore often. Abnormal pelvic floor contraction at strain is often noted in an al electromyography. Some of these patients seem to respond favorably to bi ofeedback treatment.