Obstructed defecation syndrome associated with paradoxical puborectalis contraction: osteopathic treatment versus anal biofeedback. Results of a pilot study

Background Biofeedback is the most widespread rehabilitative therapy for the treatment of anismus after failed conservative treatment. Osteopathy represents an alternative therapy for constipation. The aim of this study was to evaluate short- and long-term results of osteopathic treatment as compare...

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Veröffentlicht in:Techniques in coloproctology 2021-05, Vol.25 (5), p.589-595
Hauptverfasser: Ascanelli, S., Portinari, M., Canella, M., Solari, S., Dall’Omo, F., Danese, S., De Troia, A., Carcoforo, P.
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container_end_page 595
container_issue 5
container_start_page 589
container_title Techniques in coloproctology
container_volume 25
creator Ascanelli, S.
Portinari, M.
Canella, M.
Solari, S.
Dall’Omo, F.
Danese, S.
De Troia, A.
Carcoforo, P.
description Background Biofeedback is the most widespread rehabilitative therapy for the treatment of anismus after failed conservative treatment. Osteopathy represents an alternative therapy for constipation. The aim of this study was to evaluate short- and long-term results of osteopathic treatment as compared to biofeedback in patients with dyssynergic defecation. Methods This was a prospective cohort pilot study on 30 patients with dyssynergic defecation enrolled at the Colorectal Clinic of the University Hospital of Ferrara, Italy, from May 2015 to May 2016 and followed until May 2020. Dyssynergic defecation was defined as the inappropriate contraction of the pelvic floor or less than 20% relaxation of basal resting sphincter pressure (on anal manometry) with adequate propulsive forces during attempted defecation. Dyssynergic patients were divide into 2 treatment groups: 15 patients had osteopathy and 15 patients had biofeedback. Before and 3 months after rehabilitation treatment, all patients had anorectal manometry, defecography, and ultrasound, and were evaluated with the Cleveland Clinic Florida (CCF) constipation score, obstructed defecation syndrome (ODS) score, Colo-rectal-anal Distress Inventory (CRADI-8), Colo-rectal-anal Impact Questionnaire (CRAIQ-7), and the Brusciano Score (BS). To evaluate the efficacy of osteopathy and biofeedback in the long-term, all patients completed the above-mentioned questionnaires 5 years later via a telephone interview. Results The two treatments were similarly effective in the short term with reduction in questionnaires scores, and increase in the percentage of anal sphincter release at straining at anorectal manometry in both groups. The ODS score was significantly reduced in biofeedback group ( p  = 0.021). The 3-month post-treatment BS was lower in the osteopathy group, but this just failed to reach statistical significance ( p  = 0.050). Periodic rehabilitation reinforcements were provided. The CCF constipation score decreased significantly in the osteopathy group ( p  = 0.023) after 5 years. Conclusions Osteopathy is a promising treatment for dyssynergic defecation, and it can be associated with biofeedback.
doi_str_mv 10.1007/s10151-020-02381-9
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Results of a pilot study</title><source>SpringerLink Journals - AutoHoldings</source><creator>Ascanelli, S. ; Portinari, M. ; Canella, M. ; Solari, S. ; Dall’Omo, F. ; Danese, S. ; De Troia, A. ; Carcoforo, P.</creator><creatorcontrib>Ascanelli, S. ; Portinari, M. ; Canella, M. ; Solari, S. ; Dall’Omo, F. ; Danese, S. ; De Troia, A. ; Carcoforo, P.</creatorcontrib><description>Background Biofeedback is the most widespread rehabilitative therapy for the treatment of anismus after failed conservative treatment. Osteopathy represents an alternative therapy for constipation. The aim of this study was to evaluate short- and long-term results of osteopathic treatment as compared to biofeedback in patients with dyssynergic defecation. Methods This was a prospective cohort pilot study on 30 patients with dyssynergic defecation enrolled at the Colorectal Clinic of the University Hospital of Ferrara, Italy, from May 2015 to May 2016 and followed until May 2020. Dyssynergic defecation was defined as the inappropriate contraction of the pelvic floor or less than 20% relaxation of basal resting sphincter pressure (on anal manometry) with adequate propulsive forces during attempted defecation. Dyssynergic patients were divide into 2 treatment groups: 15 patients had osteopathy and 15 patients had biofeedback. Before and 3 months after rehabilitation treatment, all patients had anorectal manometry, defecography, and ultrasound, and were evaluated with the Cleveland Clinic Florida (CCF) constipation score, obstructed defecation syndrome (ODS) score, Colo-rectal-anal Distress Inventory (CRADI-8), Colo-rectal-anal Impact Questionnaire (CRAIQ-7), and the Brusciano Score (BS). To evaluate the efficacy of osteopathy and biofeedback in the long-term, all patients completed the above-mentioned questionnaires 5 years later via a telephone interview. Results The two treatments were similarly effective in the short term with reduction in questionnaires scores, and increase in the percentage of anal sphincter release at straining at anorectal manometry in both groups. The ODS score was significantly reduced in biofeedback group ( p  = 0.021). The 3-month post-treatment BS was lower in the osteopathy group, but this just failed to reach statistical significance ( p  = 0.050). Periodic rehabilitation reinforcements were provided. The CCF constipation score decreased significantly in the osteopathy group ( p  = 0.023) after 5 years. Conclusions Osteopathy is a promising treatment for dyssynergic defecation, and it can be associated with biofeedback.</description><identifier>ISSN: 1123-6337</identifier><identifier>EISSN: 1128-045X</identifier><identifier>DOI: 10.1007/s10151-020-02381-9</identifier><identifier>PMID: 33638728</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Biofeedback ; Colorectal Surgery ; Constipation ; Defecation ; Gastroenterology ; Medicine ; Medicine &amp; Public Health ; Osteopathic medicine ; Proctology ; Questionnaires ; Short Communication ; Surgery</subject><ispartof>Techniques in coloproctology, 2021-05, Vol.25 (5), p.589-595</ispartof><rights>Springer Nature Switzerland AG 2021</rights><rights>Springer Nature Switzerland AG 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-7666522d90cdd19a85af9a35218d443596968810afb78d9870d944cb71e01ccf3</citedby><cites>FETCH-LOGICAL-c375t-7666522d90cdd19a85af9a35218d443596968810afb78d9870d944cb71e01ccf3</cites><orcidid>0000-0002-1423-8576</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10151-020-02381-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10151-020-02381-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33638728$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ascanelli, S.</creatorcontrib><creatorcontrib>Portinari, M.</creatorcontrib><creatorcontrib>Canella, M.</creatorcontrib><creatorcontrib>Solari, S.</creatorcontrib><creatorcontrib>Dall’Omo, F.</creatorcontrib><creatorcontrib>Danese, S.</creatorcontrib><creatorcontrib>De Troia, A.</creatorcontrib><creatorcontrib>Carcoforo, P.</creatorcontrib><title>Obstructed defecation syndrome associated with paradoxical puborectalis contraction: osteopathic treatment versus anal biofeedback. Results of a pilot study</title><title>Techniques in coloproctology</title><addtitle>Tech Coloproctol</addtitle><addtitle>Tech Coloproctol</addtitle><description>Background Biofeedback is the most widespread rehabilitative therapy for the treatment of anismus after failed conservative treatment. Osteopathy represents an alternative therapy for constipation. The aim of this study was to evaluate short- and long-term results of osteopathic treatment as compared to biofeedback in patients with dyssynergic defecation. Methods This was a prospective cohort pilot study on 30 patients with dyssynergic defecation enrolled at the Colorectal Clinic of the University Hospital of Ferrara, Italy, from May 2015 to May 2016 and followed until May 2020. Dyssynergic defecation was defined as the inappropriate contraction of the pelvic floor or less than 20% relaxation of basal resting sphincter pressure (on anal manometry) with adequate propulsive forces during attempted defecation. Dyssynergic patients were divide into 2 treatment groups: 15 patients had osteopathy and 15 patients had biofeedback. Before and 3 months after rehabilitation treatment, all patients had anorectal manometry, defecography, and ultrasound, and were evaluated with the Cleveland Clinic Florida (CCF) constipation score, obstructed defecation syndrome (ODS) score, Colo-rectal-anal Distress Inventory (CRADI-8), Colo-rectal-anal Impact Questionnaire (CRAIQ-7), and the Brusciano Score (BS). To evaluate the efficacy of osteopathy and biofeedback in the long-term, all patients completed the above-mentioned questionnaires 5 years later via a telephone interview. Results The two treatments were similarly effective in the short term with reduction in questionnaires scores, and increase in the percentage of anal sphincter release at straining at anorectal manometry in both groups. The ODS score was significantly reduced in biofeedback group ( p  = 0.021). The 3-month post-treatment BS was lower in the osteopathy group, but this just failed to reach statistical significance ( p  = 0.050). Periodic rehabilitation reinforcements were provided. The CCF constipation score decreased significantly in the osteopathy group ( p  = 0.023) after 5 years. Conclusions Osteopathy is a promising treatment for dyssynergic defecation, and it can be associated with biofeedback.</description><subject>Abdominal Surgery</subject><subject>Biofeedback</subject><subject>Colorectal Surgery</subject><subject>Constipation</subject><subject>Defecation</subject><subject>Gastroenterology</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Osteopathic medicine</subject><subject>Proctology</subject><subject>Questionnaires</subject><subject>Short Communication</subject><subject>Surgery</subject><issn>1123-6337</issn><issn>1128-045X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc1qFjEUhgdRbK3egAsJuHEzNT-TSeJOilWhUBAFd8OZ5IxNnZmMORn1uxcvtvP1qwouXIQEzvO-h_BU1VPBTwXn5iUJLrSoueTbUVbU7l51LIS0NW_05_u3b1W3Spmj6hHRNefCGC0eVkdKtcoaaY-rX5c9lbz6goEFHNBDiWlmtJtDThMyIEo-wn78I5YrtkCGkH5GDyNb1j5l9AXGSMynuWTw-_QrlqhgWqBcRc9KRigTzoV9x0wrMZi3bB_TgBh68F9P2QekdSzE0sCALXFMhVFZw-5x9WCAkfDJ3X1SfTp_8_HsXX1x-fb92euL2iujS23attVSBsd9CMKB1TA4UFoKG5pGade61lrBYeiNDc4aHlzT-N4I5ML7QZ1ULw69S07fVqTSTZE8jiPMmFbqZOMaadpG2g19_g96nda8_WijtHBcycbojZIHyudElHHolhwnyLtO8G7vrju46zZ33a27zm2hZ3fVaz9h-BP5LWsD1AGgbTR_wfx3939qbwD1f6fA</recordid><startdate>20210501</startdate><enddate>20210501</enddate><creator>Ascanelli, S.</creator><creator>Portinari, M.</creator><creator>Canella, M.</creator><creator>Solari, S.</creator><creator>Dall’Omo, F.</creator><creator>Danese, S.</creator><creator>De Troia, A.</creator><creator>Carcoforo, P.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1423-8576</orcidid></search><sort><creationdate>20210501</creationdate><title>Obstructed defecation syndrome associated with paradoxical puborectalis contraction: osteopathic treatment versus anal biofeedback. Results of a pilot study</title><author>Ascanelli, S. ; Portinari, M. ; Canella, M. ; Solari, S. ; Dall’Omo, F. ; Danese, S. ; De Troia, A. ; Carcoforo, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-7666522d90cdd19a85af9a35218d443596968810afb78d9870d944cb71e01ccf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Biofeedback</topic><topic>Colorectal Surgery</topic><topic>Constipation</topic><topic>Defecation</topic><topic>Gastroenterology</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Osteopathic medicine</topic><topic>Proctology</topic><topic>Questionnaires</topic><topic>Short Communication</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ascanelli, S.</creatorcontrib><creatorcontrib>Portinari, M.</creatorcontrib><creatorcontrib>Canella, M.</creatorcontrib><creatorcontrib>Solari, S.</creatorcontrib><creatorcontrib>Dall’Omo, F.</creatorcontrib><creatorcontrib>Danese, S.</creatorcontrib><creatorcontrib>De Troia, A.</creatorcontrib><creatorcontrib>Carcoforo, P.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Techniques in coloproctology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ascanelli, S.</au><au>Portinari, M.</au><au>Canella, M.</au><au>Solari, S.</au><au>Dall’Omo, F.</au><au>Danese, S.</au><au>De Troia, A.</au><au>Carcoforo, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Obstructed defecation syndrome associated with paradoxical puborectalis contraction: osteopathic treatment versus anal biofeedback. Results of a pilot study</atitle><jtitle>Techniques in coloproctology</jtitle><stitle>Tech Coloproctol</stitle><addtitle>Tech Coloproctol</addtitle><date>2021-05-01</date><risdate>2021</risdate><volume>25</volume><issue>5</issue><spage>589</spage><epage>595</epage><pages>589-595</pages><issn>1123-6337</issn><eissn>1128-045X</eissn><abstract>Background Biofeedback is the most widespread rehabilitative therapy for the treatment of anismus after failed conservative treatment. Osteopathy represents an alternative therapy for constipation. The aim of this study was to evaluate short- and long-term results of osteopathic treatment as compared to biofeedback in patients with dyssynergic defecation. Methods This was a prospective cohort pilot study on 30 patients with dyssynergic defecation enrolled at the Colorectal Clinic of the University Hospital of Ferrara, Italy, from May 2015 to May 2016 and followed until May 2020. Dyssynergic defecation was defined as the inappropriate contraction of the pelvic floor or less than 20% relaxation of basal resting sphincter pressure (on anal manometry) with adequate propulsive forces during attempted defecation. Dyssynergic patients were divide into 2 treatment groups: 15 patients had osteopathy and 15 patients had biofeedback. Before and 3 months after rehabilitation treatment, all patients had anorectal manometry, defecography, and ultrasound, and were evaluated with the Cleveland Clinic Florida (CCF) constipation score, obstructed defecation syndrome (ODS) score, Colo-rectal-anal Distress Inventory (CRADI-8), Colo-rectal-anal Impact Questionnaire (CRAIQ-7), and the Brusciano Score (BS). To evaluate the efficacy of osteopathy and biofeedback in the long-term, all patients completed the above-mentioned questionnaires 5 years later via a telephone interview. Results The two treatments were similarly effective in the short term with reduction in questionnaires scores, and increase in the percentage of anal sphincter release at straining at anorectal manometry in both groups. The ODS score was significantly reduced in biofeedback group ( p  = 0.021). The 3-month post-treatment BS was lower in the osteopathy group, but this just failed to reach statistical significance ( p  = 0.050). Periodic rehabilitation reinforcements were provided. The CCF constipation score decreased significantly in the osteopathy group ( p  = 0.023) after 5 years. Conclusions Osteopathy is a promising treatment for dyssynergic defecation, and it can be associated with biofeedback.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>33638728</pmid><doi>10.1007/s10151-020-02381-9</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1423-8576</orcidid></addata></record>
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subjects Abdominal Surgery
Biofeedback
Colorectal Surgery
Constipation
Defecation
Gastroenterology
Medicine
Medicine & Public Health
Osteopathic medicine
Proctology
Questionnaires
Short Communication
Surgery
title Obstructed defecation syndrome associated with paradoxical puborectalis contraction: osteopathic treatment versus anal biofeedback. Results of a pilot study
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