Purpose: Dyssynergia Defecation (DD) is an underrecognized cause of chronic constipation (CC). DD occurs when a patient is unable to coordinate the abdominal wall muscles, puborectalis/anorectal angle, anal sphincter and pelvic floor in a manner which allows the normal passage of stool from the rectum. Though constipation related complaints such as reduced stool frequency, straining and a sensation of incomplete evacuation are common, DD patients also commonly endorse abdominal symptoms such discomfort, pain, cramping, and bloating. Whether abdominal symptoms improve with biofeedback training in DD patients is unclear. We aimed to assess the impact of biofeedback therapy on abdominal symptoms including discomfort, pain, cramping and bloating in DD patients.
Methods: A retrospective analysis of prospectively collected data from 65 manometrically proven DD patients who received biofeedback therapy at a tertiary center between 2008 and 2012. Each patient completed the 12 item Patient Assessment of Constipation (PAC-SYM) symptom questionnaire during their initial and discharge visits. The PAC-SYM measures abdominal complaints, rectal and stool domains related in CC patients. Paired sample t-tests were performed on the summations of the PAC-SYM and for each of the 12 individual items. P-values less than 0.05 were considered statistically significant.
Results: The mean age of the sample was 54 years. Over 70% of participants were female and Caucasian. Bowel related and abdominal symptoms were commonly reported by DD patients. There was a highly significant reduction in initial total PAC-SYM score (22.8) and the PAC-SYM score following PT (12.1) (p<0.001). While all bowel and stool related domains significantly improved, substantial benefits for abdominal symptoms were also observed (See Table 1).
Conclusion: Patients with dyssynergic defecation commonly report abdominal symptoms. Like bowel related symptoms, abdominal symptoms such as discomfort, pain and bloating significantly improve following biofeedback training.