Abstract
Background Stimulant laxatives are still considered the most common treatment for functional outlet obstruction constipation (FOOC). However, the effectiveness of laxatives is unsatisfactory, and the long-term use of laxatives may cause certain adverse events. With this in mind, it is, however, paramount that novel complementary treatment(s) and/or other forms of alternative medicine are adequately investigated. Aims The study aims to explore the effects and potential mechanism(s) of transcutaneous electrical acustimulation (TEA) combined with adaptive biofeedback training (ABT) on FOOC. Methods A total of forty-five patients with FOOC were recruited and were randomly assigned to receive either Macrogol 4000 Powder (MAC, 10 g bid) (group A, n = 15) only, ABT + MAC + Sham-TEA (group B, n = 15), or TEA + ABT + MAC (group C, n = 15) in a six-week study. Individual patients' constipation-symptoms (PAC-SYM) and constipation-quality of life (PAC-QOL) were both assessed and scored. Serum acetylcholine (Ach) and nitric oxide (NO) were measured from drawn blood samples while individual patients' heart rate variability (HRV) was calculated at baseline and after each corresponding therapy. Anorectal manometry and balloon expulsion test were both performed before and after treatment. Results Firstly, participants in group C had significantly lower scores of PAC-SYM, PAC-QOL, and a decreased anal defecating pressure (ADP) as compared to participants in group B (all p < 0.050). These results, however, suggest the TEAs effect. Secondly, the low-frequency band (LF)/(LF + HF) ratio in groups B and C were decreased as compared to group A (p=0.037, p=0.010, respectively) regarding HRV. On the other hand, the high-frequency band (HF)/(LF + HF) ratio in groups B and C showed an opposite outcome. Finally, the serum Ach in groups B and C was significantly higher as compared to group A (p=0.023, p=0.012, respectively). Of significant importance, the serum NO in groups B and C were notably low as compared to group A (p=0.001, p < 0.001, respectively). Conclusions TEA, combined with ABT, effectively improves constipation symptoms as well as QOL in FOOC patients. It is, however, achieved by decreasing ADP, which mechanisms are mediated via the autonomic and enteric mechanisms.
Highlights
Functional outlet obstruction constipation (FOOC) is painful defecation caused by pelvic floor muscles not relaxing or paradoxical contraction of the external anal sphincter and the puborectalis muscles [1,2,3]
Results indicated that the combination of transcutaneous electrical acustimulation (TEA) and adaptive biofeedback training (ABT) and ABT alone had a significant decrease in anal defecating pressure (ADP). ere was no change of the ADP in group A after MAC treatment (p 1.0), while a significant decrease was noted in group B (p < 0.050) and group C (p < 0.010) (Figure 4)
The ADP in group C was significantly lower than that in group B (47.89 ± 4.26 vs. 53.27 ± 5.23, p 0.024) and group A (47.89 ± 4.26 vs. 59.14 ± 7.06, p 0.002). ere was a significant difference in ADP after treatment when group A was compared with group B (59.14 ± 7.06 vs. 53.27 ± 5.23, p 0.019). e results suggest that both TEA and ABT lead to ADP decline with a combination of both being the most potent
Summary
Functional outlet obstruction constipation (FOOC) is painful defecation caused by pelvic floor muscles (internal anal sphincter or the striated muscles) not relaxing or paradoxical contraction of the external anal sphincter and the puborectalis muscles [1,2,3]. The effectiveness of ABT in the treatment of FOOC is limited, and a part of patients can not obtain symptoms improvement [9]. The effectiveness of laxatives is unsatisfactory, and the long-term use of laxatives may cause certain adverse events With this in mind, it is, paramount that novel complementary treatment(s) and/or other forms of alternative medicine are adequately investigated. Participants in group C had significantly lower scores of PAC-SYM, PAC-QOL, and a decreased anal defecating pressure (ADP) as compared to participants in group B (all p < 0.050). TEA, combined with ABT, effectively improves constipation symptoms as well as QOL in FOOC patients. It is, achieved by decreasing ADP, which mechanisms are mediated via the autonomic and enteric mechanisms
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Evidence-Based Complementary and Alternative Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
