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Research Article
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Colonic Slow Transit in Patients with Dyssynergic Defecation and Effectiveness of Biofeedback Therapy

Year 2023, Volume: 45 Issue: 1, 66 - 73, 31.03.2023

Derya Arı , Ömer Öztürk , Yasemin Özderin , Dilara Turan Gökçe , İlyas Tenlik , Ferhat Bacaksız , Volkan Gökbulut , Orhan Coşkun

https://doi.org/10.7197/cmj.1099119

Abstract

Background: Colonic transit is delayed in two-thirds of patients with dyssynergic defecation. As a result, it's possible that dyssynergic defecation and slow transit constipation are linked. There is a scarcity of research on the coexistence of dyssynergic defecation and slow transit constipation, as well as the efficacy of biofeedback therapy in this group of patients.

Methods: The results of anorectal manometry and MR defecography were used to make the diagnosis of dyssynergic defecation. The colon transit time was measured with the help of 24 specially marked markers. All of the patients were given biofeedback therapy.

Results: The average age of the 17 patients with dyssynergic defecation in the study was 45.6 years. The colon transit time was prolonged in seven patients (41.2%). In anorectal manometry, 7 patients (41.2%) had improved dyssynergic defecation after dyssynergic defecation. When the relationship between colon transit time and biofeedback therapy was investigated, it was discovered that normal colon transit time was found in 85.7 percent of those who benefited from biofeedback therapy, while slow transit constipation was found in 60% of those who did not.

Conclusion: In patients with pre- biofeedback therapy and dyssynergic defecation, colon transit time should be evaluated, and it should be kept in mind that these patients may be resistant to treatment in the case of accompanying slow transit constipation.

Keywords

Biofeedback therapy Colonic Slow Transit Dyssynergic Defecation

Project Number

Yok

References

  • Reference1 Rao SSC. Biofeedback therapy for constipation in adults. Best Pract Res Clin Gastroenterol 2011; 25: 159–66.
  • Reference2 Rao SSC. Dyssynergic defecation and biofeedback therapy. Gastroenterol Clin North Am 2008;37:569–86.
  • Reference3 Patcharatrakul T, Valestin J, Schmeltz A, Schulze K, Rao SSC. Factors Associated With Response to Biofeedback Therapy for Dyssynergic Defecation.Clinical Gastroenterology and Hepatology 2018;16:715–721.
  • Reference4 Wong S, Lubowski D. Slow-transit constipation: evaluation and treatment. ANZ J Surg 2007;77:320-8.
  • Reference5 Nullens, S, Nelsen, T, Camilleri, M, Burton D, Eckert D, Itiruno J, et al.. Regional colon transit in patients with dys-synergic defaecation or slow transit in patients with constipation. Gut 2012, 61, 1132–1139
  • Reference6 Chitkara DK, Bredenoord AJ, Cremonini F, Delgado-Aros S, Smoot RL, El-Youssef M, et al. The role of pelvic floor dysfunction and slow colonic transit in adolescents with refractory constipation. Am J Gastroenterol 2004;99:1579-84.
  • Reference7 Rao SSC, Benninga MA, Bharucha AE, Chiarioni G, Di Lorenzo C, Whitehead WE. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil 2015; 27:594–609.
  • Reference8 Knowles CH, Grossi U, Horrocks EJ, Pares D, Vollebregt PF, Chapman M, et al. Surgery for constipation: Systematic review and practice recommendations. Color Dis 2017;19: 101–113.
  • Reference9 Koutsomanis D, Lennard-Jomes JE, Kamm MA. Prospective study of biofeedback treatment for patients with slow and normal transit constipation. Eur. J. Gastroenterol. Hepatol. 1994;6: 131–7.
  • Reference10 Drossman DA, Hasler WL. Rome IV-functional GI disorders: Disorders of gut-brain interaction. Gastroenterology 2016;150:1257–61.
  • Reference11 Rao SSC, Mudipalli RS, Stessman M, Zimmerman B. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 2004; 16: 589–96.
  • Reference12 Lee HJ, Jun KW, Myung SJ. Technique of functional and motility test: How to perform biofeedback for constipation and fecal incontinence. J. Neurogastroenterol. Motil. 2013, 19, 532–537.
  • Reference13 Tanner S, Chaudhry A, Goraya N, Badlani R, Jehangir A, Shahsavari D, et al. Prevalence and Clinical Characteristics of Dyssynergic Defecation and Slow Transit Constipation in Patients with Chronic Constipation. J. Clin. Med. 2021;10: 2027.
  • Reference14 Grotz RL, Pemberton JH, Talley NJ, Rath DM, Zinsmeister AR. Discriminant value of psychological distress, symptom profiles, and segmental colonic dysfunction in outpatients with severe idiopathic constipation. Gut 1994;35:798-802.
  • Reference15 Bhate PA, Patel JA, Parikh P, Ingle MA, Phadke A, Sawant PD. Total and Segmental Colon Transit Time Study in Functional Constipation: Comparison With Healthy Subjects. Gastroenterol Res. 2015;8(1):157-159.
  • Reference16 Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum. 2007;50:428–441
  • Reference17 Rao SSC, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5: 331–338.
  • Reference18 Jodorkovsky D, Dunbar KB, Gearhart SL, Stein EM, Clarke JO. Biofeedback Therapy for Defecatory Dysfunction “Real Life” Experience. J Clin Gastroenterol 2013;47:252–255.
  • Reference19 Rao SSC. The Technical aspects of biofeedback therapy for defecation disorders. The Gastroenterologist 1998;6:96–103.
  • Reference20 Chiarioni G, Salandini L, Whitehead WE. Biofeedback Benefits Only Patients With Outlet Dysfunction, Not Patients With Isolated Slow Transit Constipation. Gastroenterology 2005, 129, 86–97.
  • Reference21 Mollen RMHG, Salvioli B, Camilleri M, Burton, D, Kost LJ, Phillips SF, Pemberton JH. The effects of biofeedback on rectal sensation and distal colonic motility in patients with disorders of rectal evacuation: Evidence of an inhibitory rectocolonic reflex in humans? Am. J. Gastroenterol. 1999, 94, 751–756.
  • Reference22 Chiotakakou-Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Biofeedback provides long term benefit for patients with intractable, slow and normal transit constipation. Gut 1998, 42, 517–521.
  • Reference23 Koutsomanis D, Lennard-Jones J, Kamm MA. Prospective study of biofeedback treatment for patients with slow and normal transit constipation. Eur J Gastroenterol Hepatol 1994;6:131–7.
  • Reference24 Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006;130:657–64.
  • Reference25 Chiarioni, G, Salandini L, Whitehead WE. Biofeedback Benefits Only Patients With Outlet Dysfunction, Not Patients With Isolated Slow Transit Constipation. Gastroenterology 2005; 129: 86–97.
  • Reference26 Lee HJ, Boo SJ, Jung KW, Han S, Seo SY, Yoon IJ, et al. Long-term efficacy of biofeedback therapy in patients with dyssynergic defecation: results of a median 44 months follow-up. Neurogastroenterol Motil 2015 27, 787–795
  • Reference27 Rao SSC, Welcher K, Leistikow J. Obstructive Defecation. A failure of rectoanal coordination. Am J Gastroenterol 1998;93:1042–50
  • Reference28 Rao SCC, Valestin J, Brown CK, Zimmerman B, Schulze K. Long Term Effıcacy of Bıofeedback Therapy for Dyssynergıa -Randomızed Controlled Trıal. Am J Gastroenterol. 2010 April; 105(4): 890–896

Year 2023, Volume: 45 Issue: 1, 66 - 73, 31.03.2023

Derya Arı , Ömer Öztürk , Yasemin Özderin , Dilara Turan Gökçe , İlyas Tenlik , Ferhat Bacaksız , Volkan Gökbulut , Orhan Coşkun

https://doi.org/10.7197/cmj.1099119

Abstract

Supporting Institution

Yok

Project Number

Yok

References

  • Reference1 Rao SSC. Biofeedback therapy for constipation in adults. Best Pract Res Clin Gastroenterol 2011; 25: 159–66.
  • Reference2 Rao SSC. Dyssynergic defecation and biofeedback therapy. Gastroenterol Clin North Am 2008;37:569–86.
  • Reference3 Patcharatrakul T, Valestin J, Schmeltz A, Schulze K, Rao SSC. Factors Associated With Response to Biofeedback Therapy for Dyssynergic Defecation.Clinical Gastroenterology and Hepatology 2018;16:715–721.
  • Reference4 Wong S, Lubowski D. Slow-transit constipation: evaluation and treatment. ANZ J Surg 2007;77:320-8.
  • Reference5 Nullens, S, Nelsen, T, Camilleri, M, Burton D, Eckert D, Itiruno J, et al.. Regional colon transit in patients with dys-synergic defaecation or slow transit in patients with constipation. Gut 2012, 61, 1132–1139
  • Reference6 Chitkara DK, Bredenoord AJ, Cremonini F, Delgado-Aros S, Smoot RL, El-Youssef M, et al. The role of pelvic floor dysfunction and slow colonic transit in adolescents with refractory constipation. Am J Gastroenterol 2004;99:1579-84.
  • Reference7 Rao SSC, Benninga MA, Bharucha AE, Chiarioni G, Di Lorenzo C, Whitehead WE. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil 2015; 27:594–609.
  • Reference8 Knowles CH, Grossi U, Horrocks EJ, Pares D, Vollebregt PF, Chapman M, et al. Surgery for constipation: Systematic review and practice recommendations. Color Dis 2017;19: 101–113.
  • Reference9 Koutsomanis D, Lennard-Jomes JE, Kamm MA. Prospective study of biofeedback treatment for patients with slow and normal transit constipation. Eur. J. Gastroenterol. Hepatol. 1994;6: 131–7.
  • Reference10 Drossman DA, Hasler WL. Rome IV-functional GI disorders: Disorders of gut-brain interaction. Gastroenterology 2016;150:1257–61.
  • Reference11 Rao SSC, Mudipalli RS, Stessman M, Zimmerman B. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 2004; 16: 589–96.
  • Reference12 Lee HJ, Jun KW, Myung SJ. Technique of functional and motility test: How to perform biofeedback for constipation and fecal incontinence. J. Neurogastroenterol. Motil. 2013, 19, 532–537.
  • Reference13 Tanner S, Chaudhry A, Goraya N, Badlani R, Jehangir A, Shahsavari D, et al. Prevalence and Clinical Characteristics of Dyssynergic Defecation and Slow Transit Constipation in Patients with Chronic Constipation. J. Clin. Med. 2021;10: 2027.
  • Reference14 Grotz RL, Pemberton JH, Talley NJ, Rath DM, Zinsmeister AR. Discriminant value of psychological distress, symptom profiles, and segmental colonic dysfunction in outpatients with severe idiopathic constipation. Gut 1994;35:798-802.
  • Reference15 Bhate PA, Patel JA, Parikh P, Ingle MA, Phadke A, Sawant PD. Total and Segmental Colon Transit Time Study in Functional Constipation: Comparison With Healthy Subjects. Gastroenterol Res. 2015;8(1):157-159.
  • Reference16 Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum. 2007;50:428–441
  • Reference17 Rao SSC, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5: 331–338.
  • Reference18 Jodorkovsky D, Dunbar KB, Gearhart SL, Stein EM, Clarke JO. Biofeedback Therapy for Defecatory Dysfunction “Real Life” Experience. J Clin Gastroenterol 2013;47:252–255.
  • Reference19 Rao SSC. The Technical aspects of biofeedback therapy for defecation disorders. The Gastroenterologist 1998;6:96–103.
  • Reference20 Chiarioni G, Salandini L, Whitehead WE. Biofeedback Benefits Only Patients With Outlet Dysfunction, Not Patients With Isolated Slow Transit Constipation. Gastroenterology 2005, 129, 86–97.
  • Reference21 Mollen RMHG, Salvioli B, Camilleri M, Burton, D, Kost LJ, Phillips SF, Pemberton JH. The effects of biofeedback on rectal sensation and distal colonic motility in patients with disorders of rectal evacuation: Evidence of an inhibitory rectocolonic reflex in humans? Am. J. Gastroenterol. 1999, 94, 751–756.
  • Reference22 Chiotakakou-Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Biofeedback provides long term benefit for patients with intractable, slow and normal transit constipation. Gut 1998, 42, 517–521.
  • Reference23 Koutsomanis D, Lennard-Jones J, Kamm MA. Prospective study of biofeedback treatment for patients with slow and normal transit constipation. Eur J Gastroenterol Hepatol 1994;6:131–7.
  • Reference24 Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006;130:657–64.
  • Reference25 Chiarioni, G, Salandini L, Whitehead WE. Biofeedback Benefits Only Patients With Outlet Dysfunction, Not Patients With Isolated Slow Transit Constipation. Gastroenterology 2005; 129: 86–97.
  • Reference26 Lee HJ, Boo SJ, Jung KW, Han S, Seo SY, Yoon IJ, et al. Long-term efficacy of biofeedback therapy in patients with dyssynergic defecation: results of a median 44 months follow-up. Neurogastroenterol Motil 2015 27, 787–795
  • Reference27 Rao SSC, Welcher K, Leistikow J. Obstructive Defecation. A failure of rectoanal coordination. Am J Gastroenterol 1998;93:1042–50
  • Reference28 Rao SCC, Valestin J, Brown CK, Zimmerman B, Schulze K. Long Term Effıcacy of Bıofeedback Therapy for Dyssynergıa -Randomızed Controlled Trıal. Am J Gastroenterol. 2010 April; 105(4): 890–896
There are 28 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Medical Science Research Articles
Authors

Derya Arı 0000-0001-8024-781X

Ömer Öztürk 0000-0002-4545-7149

Yasemin Özderin 0000-0002-8744-4936

Dilara Turan Gökçe 0000-0003-3660-7237

İlyas Tenlik 0000-0001-9546-2918

Ferhat Bacaksız 0000-0002-9670-3290

Volkan Gökbulut 0000-0002-7906-2479

Orhan Coşkun 0000-0002-3124-9517

Project Number Yok
Publication Date March 31, 2023
Acceptance Date March 26, 2023
Published in Issue Year 2023 Volume: 45 Issue: 1

Cite

AMA Arı D, Öztürk Ö, Özderin Y, et al. Colonic Slow Transit in Patients with Dyssynergic Defecation and Effectiveness of Biofeedback Therapy. CMJ. March 2023;45(1):66-73. doi:10.7197/cmj.1099119
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