Pelvic Floor Dyssynergia Research Articles

Antegrade Continence Enema Alone for the Management of Functional Constipation and Segmental Colonic Dysmotility (ACE-FC): A Pediatric Colorectal and Pelvic Learning Consortium Study.

The purpose of the study was to determine if antegrade continence enema (ACE) alone is an effective treatment for patients with severe functional constipation and segmental colonic dysmotility. A retrospective study of patients with functional constipation and segmental colonic dysmotility who underwent ACE as their initial means of management. Data was collected from six participating sites in the Pediatric Colorectal and Pelvic Learning Consortium. Patients who had a colonic resection at the same time as an ACE or previously were excluded from analysis. Only patients who were 21 years old or younger and had at least 1-year follow-up after ACE were included. All patients had segmental colonic dysmotility documented by colonic manometry. Patient characteristics including preoperative colonic and anorectal manometry were summarized, and associations with colonic resection following ACE were evaluated using Fisher's exact test and Wilcoxon rank-sum test. p-Values of less than 0.05 were considered significant. Statistical analyses and summaries were performed using SAS version 9.4 (SAS Institute Inc., Cary, North Carolina, United States). A total of 104 patients from 6 institutions were included in the study with an even gender distribution (males n = 50, 48.1%) and a median age of 9.6 years (interquartile range 7.4, 12.8). At 1-year follow-up, 96 patients (92%) were successfully managed with ACE alone and 8 patients (7%) underwent subsequent colonic resection for persistent symptoms. Behavioral disorder, type of bowel management, and the need for botulinum toxin administered to the anal sphincters was not associated with the need for subsequent colonic resection. On anorectal manometry, lack of pelvic floor dyssynergia was significantly associated with the need for subsequent colonic resection; 3/8, 37.5% without pelvic dyssynergia versus 1/8, 12.5% (p = 0.023) with pelvic dyssynergia underwent subsequent colonic resection. In patients with severe functional constipation and documented segmental colonic dysmotility, ACE alone is an effective treatment modality at 1-year follow-up. Patients without pelvic floor dyssynergia on anorectal manometry are more likely to receive colonic resection after ACE. The vast majority of such patients can avoid a colonic resection.

S768 Biofeedback Therapy is Effective in All Types of Pelvic Floor Dyssynergia: A Tertiary Care Centre Experience From India

S768 Biofeedback Therapy is Effective in All Types of Pelvic Floor Dyssynergia: A Tertiary Care Centre Experience From India

S811 Utilizing Anorectal Parameters in Pelvic Floor Dyssynergia to Predict Parkinson’s Disease With Implications for Response to Biofeedback

S811 Utilizing Anorectal Parameters in Pelvic Floor Dyssynergia to Predict Parkinson’s Disease With Implications for Response to Biofeedback

Management of the child with refractory constipation.

Caring for children with constipation refractory to conventional treatment can be challenging and management practices vary widely. To review recent advances in the evaluation and treatment of children with refractory constipation and to propose an algorithm that incorporates the latest evidence and our institutional experience. We performed a literature review on diagnostic tests and treatment options for children with refractory constipation. Evaluation of a child with refractory constipation seeks to better understand factors contributing to an individual child's presentation. Anorectal manometry evaluating for a rectal evacuation disorder and colonic manometry evaluating for colonic dysmotility can guide subsequent treatment. For the child who has not responded to conventional treatment, a trial of newer medications like linaclotide can be helpful. Transanal irrigation offers a safe and effective alternative for families able to administer daily rectal treatment. Despite mixed evidence in children, pelvic floor biofeedback therapy can help some children with pelvic floor dyssynergia. For younger children unable to cooperate with pelvic floor therapy, or older children with refractory symptoms, internal anal sphincter botulinum toxin injection can be beneficial. Antegrade continence enema treatment can be effective for children with either normal colonic motility or segmental dysmotility. Sacral nerve stimulation is generally reserved for symptoms that persist despite antegrade continence enemas, particularly if faecal incontinence is prominent. In more severe cases, temporary or permanent colonic diversion and segmental colonic resection may be needed. Recent advances offer hope for children with refractory constipation.

Imaging of the pelvic floor (MR defecography) : The surgeon's perspective

Magnetic resonance defecography (MRD) plays acentral role in diagnosing pelvic floor functional disorders by visualizing the entire pelvic floor along with pelvic organs and providing functional assessment of the defecation process. Ashared understanding between radiology and surgery regarding indications and interpretation of findings is crucial for optimal utilization of MRD. This review aims to explain the indications for MRD from asurgical perspective and elucidate the significance of radiological findings for treatment. It intends to clarify for which symptoms MRD is appropriate and which criteria should be followed for standardized results. This is prerequisite to develop interdisciplinary therapeutic approaches. Acomprehensive literature search was conducted, including current consensus guidelines. MRD can provide relevant findings in the diagnosis of fecal incontinence and obstructed defecation syndrome, particularly in cases of pelvic floor descent, enterocele, intussusception, and pelvic floor dyssynergia. However, rectocele findings in MRD should be interpreted with caution in order to avoid overdiagnosis. MRD findings should never be considered in isolation but rather in conjunction with patient history, clinical examination, and symptomatology since morphology and functional complaints may not always correlate, and there is wide variance of normal values. Interdisciplinary interpretation of MRD results involving radiology, surgery, gynecology, and urology, preferably in the context of pelvic floor conferences, is recommended.

Interstitial cystitis caused by immune dysregulation in LRBA deficiency: one among the rare urological manifestations in inborn errors of immunity

Inborn errors of immunity (IEI) rarely present with associated urological manifestations. Chronic cystitis and urethritis caused by ureaplasma and mycoplasma infection in hypogammaglobulinemia may result in bladder fibrosis. Papovaviridae such as BK or JC, can cause hemorrhagic cystitis in patients with T cell defects. Bladder granulomtata and urethral strictures can occur in chronic granulomatous disease. This is the first reported case of severe lymphocytic interstitial cystitis in a patient with lipopolysaccharide-responsive beige-like anchor protein (LRBA) deficiency. LRBA deficiency is known to impair CTLA-4 recycling, leading to decreased Treg cell function. A 13 year old male refugee presented with chronic recurrent debilitating suprapubic pain and dysuria, which progressed to extreme urinary frequency. He had a prior history of recurrent aseptic urinary tract infections, and one episode of gross hematuria. Extensive infectious investigations of urine (bacterial, mycobacterial cultures; viral PCRs), blood, and stool (Schistosoma) failed to isolate a pathogen. Bladder biopsy was positive for EBV by PCR but blood remained EBV-negative. Urinalysis showed microscopic hematuria while urodynamic studies were normal, and cystoscopy showed bladder and urethral irritation. Pathology confirmed lymphocytic interstitial cystitis, with primarily T cell infiltration. Immunological investigations revealed low IgG, IgA and IgM levels, B lymphopenia (1%), with low class-switched memory B cell development (3%) and absent response to protein and polysaccharide vaccine antigens. There were no signs of autoimmunity. Parents are consanguineous, and a sibling was likewise diagnosed with LRBA deficiency. Sanger sequencing of DNA confirmed the same homozygous family mutation in the LRBA gene, a likely pathogenic splice donor variant, c.2258+2T>G. The patient was started on immunoglobulin replacement. Trials of analgesics including NSAIDs, gabapentin, and morphine, and immunosuppression with corticosteroids and sirolimus, were unsuccessful in reducing urinary symptoms. Physiotherapy and antispasmodics were introduced when pelvic-floor dyssynergia with rectal pain developed. Subsequently-presenting enteropathy was managed with Abatacept (CTLA-4 IgG1 fusion protein), ultimately improving bladder symptoms after several months of therapy. Patient has since undergone HSCT and is now free of urinary tract symptoms. LRBA deficiency presents with hypogammaglobulinemia, infections, and immune dysregulation presenting with lymphocytic infiltration of non-lymphoid organs. This report highlights the phenotypic diversity of this disease.

Biofeedback Treatment Can Improve Clinical Condition and Quality of Life in Patients with Pelvic Floor Dyssynergy with Irritable Bowel Syndrome: A Prospective Cohort Study.

Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Methods: This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Results: Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion: Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.

To what extent are anorectal function tests comparable? A study comparing digital rectal examination, anal electromyography, 3-dimensional high-resolution anal manometry, and transperineal ultrasound

BackgroundAnorectal function tests are helpful for objective investigation of anorectal (dys)function. A variety of tests are available, but there is no recommendation when to perform which test. Furthermore, which test is the most accurate is controversial and the correlation between these tests is not very clear. The aim of our study was to examine the correlation of anal pressures and the possibility to diagnose pelvic floor dyssynergia between digital rectal examination (DRE) and several anorectal function tests.MethodsBetween January 2020 and April 2022, all men and women aged 18 to 80 years, treated at the Proctos Clinic, who were referred for pelvic floor physical therapy (PFPT) by the surgeon and underwent anorectal function tests, were included. DRE was performed to establish the anal pressure at rest and during squeeze and straining. Anorectal function tests included 3D high-resolution anal manometry (3D-HRAM), balloon expulsion test (BET), transperineal ultrasound (TPUS), and surface electromyography (s-EMG).ResultsA total of 50 patients, 37 (74%) females, were included. Median age was 51 years. Twenty-three (62%) females had a history of two or more vaginal deliveries. The most frequent reason for referral for PFPT was fecal incontinence in 27 (54%) patients. The assessed pressures and pelvic floor function measured with DRE by the surgeon and the pelvic floor physical therapist during rest, squeeze, and straining correlated in 78%, 78%, and 84%, respectively. Correlation between DRE and 3D-HRAM or s-EMG was better for squeeze pressures than resting pressures. The correlation between s-EMG and 3D-HRAM was better during squeeze than at rest with an agreement of 59% and 37%, respectively.ConclusionDRE by an experienced investigator is of sufficient value for daily clinical practice to detect dyssynergia and to measure sphincter tone. Commonly performed anorectal function tests correlate poorly with DRE and with other anorectal function tests. When conservative treatment fails, further investigation is warranted; however, these results should be interpreted with caution.What does this paper add to the literature?Anorectal function tests such as the 3D high-resolution anorectal manometry, balloon expulsion test, surface electromyography, and transperineal ultrasound are all frequently performed in the diagnostic workup in patients with defecation disorders. No previous study has compared these tests regarding their outcomes, nor has the interrater agreement been measured regarding the digital rectal examination by two experienced observers. Furthermore, transperineal ultrasound is in all probability not frequently used and therefore underexposed in the diagnostic workup of patients with dyssynergic defecation.

S2466 Pelvic Floor Dysfunction as a Cause of Chronic Intestinal Pseudo Obstruction

Introduction: Chronic intestinal pseudo-obstruction (CIPO) is a rare motility disorder with a variety of secondary causes, including genetics, metabolic disease, paraneoplastic syndromes, inflammatory disorders, and neurologic disorders. We present a case of CIPO secondary to pelvic floor dyssynergia. Case Description/Methods: A 64 year-old male with a past medical history of hypertension, atrial tachycardia, and heavy alcohol use was referred for further GI workup by his primary care physician following a 5 month history of worsening constipation after a viral infection. Prior to the infection, he had a bowel movement 2-3 times per week. However, he now describes one Bristol 4 or 7 bowel movement with straining per month. Symptoms were refractory to Dulcolax and Colace. Initial workup included a normal extended electrolyte panel, normal TSH, and negative Celiac disease serologies. A CT abdomen and pelvis revealed extensive dilation of proximal colon, compression of descending and sigmoid colon, and small bowel fecalization. A representative coronal image is shown in Figure 1. Subsequent colonoscopy did not reveal any evidence of obstruction. Anorectal manometry (ARM) findings included elevated resting pressure (74.94 mmHg), decreased sensation, paradoxical contraction with Valsalva, and inability to pass the balloon catheter after 2.5 minutes. Normal rectal capacity (280 mL) and excellent squeeze pressure but paradoxical contraction with Valsalva is consistent with pelvic floor dyssynergia. Biofeedback therapy was recommended. Discussion: Evaluating for secondary causes of CIPO (i.e., obstruction, metabolic disturbances, autoimmune disorders, neurologic disorders, and musculoskeletal disorders) is an important diagnostic step. Key tests include imaging, colonoscopy, electrolytes and autoimmune panels, and anorectal manometry. This case highlights long-standing pelvic floor dyssynergia as an underlying cause of CIPO.Figure 1.: CT abdomen and pelvis with extensive dilation of proximal colon and small bowel fecalization.

A rare and unique inflammatory anorectal lesion.

A 50-year-old Caucasian woman, without relevant past medical history, was referred to the gastroenterology consultation due to chronic constipation. She had no previous endoscopic evaluation or past surgeries. The digital rectal examination revealed a soft mobile mass at the lower rectum. Pelvic floor dyssynergia was diagnosed on magnetic resonance defecography and, therefore, biofeedback therapy was started. Colonoscopy revealed a light yellowish sessile polyp with 20 mm at the anorectal junction (Figure 1).

ID:15782 Dorsal Root Ganglion Stimulation for Chronic Penile Pain and Fecal Urge With Incontinence

We present the case of a 58-year-old man who underwent DRG stimulation for chronic penile pain with unexpected resolution of fecal urge with incontinence. He initially presented with 8 months of penile pain, 10 years of fecal urgency, and 5 years of fecal incontinence. He had minimal benefit with pelvic physical therapy, Sitz baths, and medications via oral, transdermal, and rectal routes. Magnetic resonance imaging (MRI) lumbar neurogram was unremarkable, and MRI total spine was notable for severe right neuroforaminal narrowing at L4-5. Anorectal manometry and pudendal nerve terminal motor latency testing revealed signs of pelvic floor dyssynergia, including paradoxical puborectalis muscle contraction with Valsalva maneuver and altered rectal sensation. He had minimal relief with bilateral pudendal nerve blocks, left S2 and S3 selective nerve root blocks, and trigger point injections of the left puborectalis muscle.

Obstruktive Defäkationsstörungen

BackgroundObstructed defecation is a subcategory of chronic constipation, representing an outlet obstruction of the rectum that can be associated with severe functional impairment and decreased quality of life.ObjectivesThe aim is to present the diagnostic assessment, differential diagnoses, and treatment options for obstructed defecation and their evaluation against the background of current studies.Materials and methodsSelected studies are presented.ResultsDiagnosis of obstructed defecation syndrome requires a meticulous workup in order to rule out pelvic floor dyssynergia or slow transit constipation. After primary conservative treatment with medication, pelvic floor retraining and irrigation, surgical procedures can be considered in case of refractory course and evidence of morphological changes as rectocele or intussusception, with adequate functional results.ConclusionsPatient selection and an accurate diagnostic evaluation are decisive for successful treatment of obstructed defecation syndrome.

Biofeedback, biofeedback plus fiber laxative, and biofeedback plus osmotic laxative regimens to treat constipation in patients with pelvic floor dyssynergia: A randomized controlled trial.

Pelvic floor dyssynergia (PFD) is one of the causes of chronic constipation. Laxative-based therapies are not very effective in treating this type of constipation. The therapeutic effectiveness of three therapeutic strategies, including biofeedback (BOF) alone, BOF+ fiber laxative (psyllium), and BOF +osmotic laxative (polyethylene glycol; [PEG]), was assessed in patients with constipation secondary to PFD. Eighty-eight patients with constipation were included during a periodfrom 2017 to 2018. Thirty-two patients were treated with BOF alone, 25 patients received BOF+ fiber laxative (psyllium), and 31 patients received BOF+ osmotic laxative (PEG) for 2 to 3 months. A checklist was used to compare outcomes before and after the interventions. Satisfaction rates from the treatments were 60.83%, 46.88%, and 41.32% in the BOF, BOF + psyllium, and BOF + PEG groups, respectively. Women had a higher satisfaction rate compared to men. Defecation quality improved, and the frequency of enema usage decreased (p <0.05) in all the groups afterintervention. Difficulty in evacuation, need for digitation, and return to the toilet after defecation significantly improved in the BOFalone group. Using laxatives reduced straining during evacuation and increased the duration of defecation. All the three regimens reduced rectal bleeding (p <0.05). Combinations of laxatives with BOF did not offer significant therapeutic benefit. As laxatives may cause dissatisfaction and incomplete/prolonged defecations in patients with PFD, adding laxatives to the BOF regimen is not recommended for these patients.

Clinical value of positive BET and pelvic floor dyssynergia in Chinese patients with functional defecation disorder

Background Functional defecation disorder (FDD) is a common subtype of functional constipation (FC). Balloon expulsion test (BET) and high resolution anorectal manometry (HR-ARM) are significant tools but their results are not always consistent. Aims To investigate the characteristics of patients with positive BET and pelvic floor dyssynergia (PFD) and explore the value of both positive results in FDD diagnosis. Methods We retrospectively diagnosed FC subtypes and enrolled FDD patients based on Rome-IV criteria. They underwent HR-ARM, BET and CTT tests. Then they were classified to two groups and further stratified by FDD subtypes. Validated questionnaires were applied to investigate patients’ constipation, anxiety/depression and quality of life. Results 335 FDD patients were finally enrolled. They were classified into two groups according to whether BET and PFD were both positive (consistent or not). 84.48% showed consistent results. These patients had significantly higher anal residual pressure, lower anal relaxation rate, manometric defecation index (MDI) and a more negative rectoanal pressure gradient (RAPG) (Ps < .05). The specific distribution of FDD phenotypes in two groups showed significant difference (p = .021). Males suffered a more negative RAPG (p < .001) and age was correlated with anal relaxation rate (p < .001). A subset (177 individuals) was investigated with validated questionnaires. Scores for Defecation Symptoms, Physical Discomfort and GAD-7 score were significantly high in Consistent Group (Ps < .05). GAD-7 score was associated with Defecation Symptoms (p < .001) while anal residual pressure, GAD-7 and Defecation Symptoms score were linked to Physical Discomfort (Ps < .05). The diagnostic specificity and PPV for FDD rose significantly with positive BET and PFD. Conclusion FDD patients with positive BET and PFD suffered from severe defecation symptoms, anxiety and impaired QOL. Positive BET and PFD could be an ideal tool for screening FDD.

Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-study): Study protocol for a randomized controlled trial

BackgroundChronic anal fissure (CAF) is a common cause of severe anorectal pain with a high incidence rate. Currently, a wide range of treatment options are available with recurrence rates varying between 7 and 42%. Pelvic floor physical therapy (PFPT) is a treatment option for increased pelvic floor muscle tone and dyssynergia which often accompanies CAF. However, literature on this subject is scarce. The Pelvic Floor Anal Fissure (PAF)-study aims to determine the efficacy and effectiveness of PFPT on improvement on pelvic floor muscle tone and function, pain, healing of the fissure, quality of life and complaint reduction in patients with CAF. MethodsThe PAF-study is a single-centre, two armed, randomized controlled trial. Patients with CAF and pelvic floor dysfunction are eligible for inclusion. Exclusion criteria include abscess, fistula, Crohn's disease, ulcerative colitis, anorectal malignancy, prior rectal radiation, and pregnancy. A total of 140 patients will be randomized for either PFPT or postponed treatment of PFPT.The primary outcome is tone at rest during electromyographic registration of the pelvic floor before and after therapy. Secondary outcomes consist of healing of the fissure, pain ratings, improvement of pelvic floor function, complaint reduction and quality of life. Primary and secondary endpoints are measured at 8 and 20 weeks and at 1-year follow-up. DiscussionCurrently, there is a gap in treatment modalities between conservative management and surgery. This manuscript prescribes the rationale, design, and methodology of a randomized controlled trial investigating PFPT as a treatment option for patients with CAF.

Investigations of Anorectal Function

Investigations of Anorectal Function Abstract. Investigations of anorectal function allows measurement of anal sphincter pressure, evaluation of rectal sensitivity and verification of rectoanal reflexes, which are essential elements in the assessment of bowel emptying. It is combined with a balloon expulsion test to ensure that the manometric findings are consistent with anorectal function. These tests are used in the diagnostic work-up of chronic defecation disorders, constipation and faecal incontinence, but can also provide clarification in the pre- and post-operative setting, for functional anorectal pain and other disorders of pelvic floor function. Most patients referred for investigation of these symptoms require a comprehensive assessment of anorectal structure and function. Because of the high variability of normal values and complexity of anorectal function, no single examination provides all the information needed to make a symptom-explaining, conclusive diagnosis and influence treatment decisions. Anorectal manometry is useful to assess the extent of impairment of anorectal function and to differentiate between organic and functional disorders (including pelvic floor dyssynergia). A preceding detailed anamnesis as well as endoscopic (procto / rectoscopy) and imaging procedures (anorectal endosonography, dynamic MR defecography) complete the diagnostic investigation instead.

Biofeedback Therapy in Children with Functional Constipation in Tehran, Iran

Background: Functional constipation is a common disorder in pediatrics and affects about 30 percent of children, causing several physical and emotional complications and having a considerable impact on health expenses and quality of life. Biofeedback is a behavioral therapy that gives the patient information about the activity of pelvic floor muscles and teaches the patients how to properly contract and relax the sphincter. Biofeedback therapy is the most effective in those with constipation due to pelvic floor dyssynergia, which is the abnormal function of sphincter muscles and affects 40% of children with constipation. Objectives: This study aimed to evaluate the effect of biofeedback therapy in children with chronic functional constipation unresponsive to medical and conventional treatments. Methods: Forty-four children with functional constipation (according to ROME 4 criteria) unresponsive to at least six months of taking medical treatment and pelvic floor dyssynergia according to anorectal manometry were selected for biofeedback therapy. After six months, symptoms of patients and the need for laxative consumption were compared to those before therapy. Results: Considering ROME 4 criteria, clinical improvement was achieved in 59.1% of patients. Comparison of symptoms shows improvement in 52 - 89 % of cases. Conclusions: In pediatric patients with functional constipation and pelvic floor dyssynergia who do not respond to conventional treatments, biofeedback therapy could be an alternative therapy, and its effects last for at least six months.

Diagnosis and management of pelvic floor dyssynergia

The term pelvic floor dyssynergia is commonly used interchangeably with the terms anismus, dyssynergic defecation or puborectalis syndrome. Patients with PFD commonly present with chronic constipation. The prevalence among the general population can range from 20-70% and among constipated patients it has been reported as high as 60%. This defecation disorder is basically caused by failure of relaxation or paradoxical contraction of the external anal sphincter and the puborectalis sling during defecation. Although there is no clear pathophysiological cause for this disorder, it has been linked to several factors such as abuse in childhood, poor toilet training, difficult childbirth, previous pelvic surgery or other psychological factors. The correct diagnosis is key to treating PFD and it starts with a thorough history and physical exam including a well performed digital rectal examination. Appropriate investigations following the initial visit can help to confirm the diagnosis and then treatment is prescribed accordingly. The patient should understand the nature of her constipation problem and participate fully in the management. The treatment is mainly conservative with diet, biofeedback and physiotherapy as the cornerstones of management. A multidisciplinary team approach will help for successful management of the patient. Surgery is normally not necessary for these patients and is only performed in extremely difficult refractory cases. By taking the time to make the correct diagnosis, patients with PFD can avoid frustration, unnecessary testing and surgery.

S0207 The Lack of Adherence to Biofeedback Therapy in Those Diagnosed With Pelvic Floor Dyssynergia

S0207 The Lack of Adherence to Biofeedback Therapy in Those Diagnosed With Pelvic Floor Dyssynergia

Biofeedback for Pelvic Floor Disorders.

Defecatory disorders can include structural, neurological, and functional disorders in addition to concomitant symptoms of fecal incontinence, functional anorectal pain, and pelvic floor dyssynergia. These disorders greatly affect quality of life and healthcare costs. Treatment for pelvic floor disorders can include medications, botulinum toxin, surgery, physical therapy, and biofeedback. Pelvic floor muscle training for pelvic floor disorders aims to enhance strength, speed, and/or endurance or coordination of voluntary anal sphincter and pelvic floor muscle contractions. Biofeedback therapy builds on physical therapy by incorporating the use of equipment to record or amplify activities of the body and feed the information back to the patients. Biofeedback has demonstrated efficacy in the treatment of chronic constipation with dyssynergic defecation, fecal incontinence, and low anterior resection syndrome. Evidence for the use of biofeedback in levator ani syndrome is conflicting. In comparing biofeedback to pelvic floor muscle training alone, studies suggest that biofeedback is superior therapy.