Abstract
Pelvic floor outlet obstruction is a rare cause of severe constipation. Anal myectomy, subtotal colectomy, and medical therapy have limited success. The purpose of this study was to develop a short outpatient treatment using biofeedback techniques. Nine patients with severe constipation and straining resulting from pelvic floor outlet obstruction underwent complete investigation of the pelvic floor musculature and anal sphincter mechanism. Patients were unable to expel a 60-cc rectal balloon and had nonrelaxing puborectalis on defecography. The treatment protocol utilized anal surface electromyography to document improper straining and retrain pelvic floor muscles to relax during defecation. Sensory retraining with a rectal balloon, behavioral relaxation techniques, and defecation of simulated stool using a 120-cc Metamucil® (Procter & Gamble, Cincinnati, OH) slurry in the rectum allowed re-establishment of normal defecation in all nine patients. Repeat training was required in three patients during follow-up. Treatment of pelvic floor outlet obstruction with outpatient retraining techniques is possible.
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References
Kuijpers HC, Bleijenberg G. The spastic pelvic floor syndrome: a cause of constipation. Dis Colon Rectum 1985;28:669–72.
Bartolo DC, Roe AM, Virjee J, Mortensen N, Lucke-Edmunds JC. An analysis of rectal morphology in obstructed defecation. Int J Colorectal Dis 1988;3:17–22.
Kuijpers HC, Bleijenberg G, Morree H. The spastic floor syndrome: large bowel obstruction caused by pelvic floor dysfunction: a radiological study. Int J Colorectal Dis 1986;1:44–8.
Turnbull GK, Lennard-Jones JE, Bartram CI. Failure of rectal explusion as a cause of constipation: why fibre and laxatives sometimes fail. Lancet 1986;1:767–9.
Keighley MR, Shouler P. Clinical and manometric features of the solitary rectal ulcer syndrome. Dis Colon Rectum 1984;27:507–12.
Roe AM, Bartolo DC, Mortensen NJ. Diagnosis and surgical management of intractable constipation. Br J Surg 1986;73:854–61.
Lestar B, Penninckx FM, Kerremans RP. Defecometry: a new method for determining the parameters of rectal evacuation. Dis Colon Rectum 1989;32:197–201.
Kuijpers HC. Application of the colorectal laboratory in diagnosis and treatment of functional constipation. Dis Colon Rectum 1990;33:35–9.
Jones PN, Lubowski DZ, Swash M, Henry MM. Is paradoxical contraction of puborectalis muscle of functional importance? Dis Colon Rectum 1987;30:667–70.
Yoshioka K, Keighley M. Anorectal myectomy for outlet obstruction. Br J Surg 1987;74:373–6.
Heaton ND, Howard ER. Anorectal myectomy: a valuable treatment for chronic constipation. Gut 1985;26:A1130.
Barnes JM, Hawley PR, Preston DM, Lennard-Jones JE. Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Br J Surg 1985;72:475–7.
Weber J, Ducrotte PH, Touchais JY, Roussignol C, Denis PH. Biofeedback training for constipation in adults and children. Dis Colon Rectum 1987;30:844–6.
Vasilevsky CA, Nemer FD, Balcos EG, Christenson CE, Goldberg SM. Is subtotal colectomy a viable option in the management of chronic constipation? Dis Colon Rectum 1988;31:679–81.
Bleijenberg G, Kuijpers HC. Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 1987;30:108–11.
Hoffman MJ, Kodner IJ, Fry RD. Internal intussusception of the rectum: diagnosis and surgical management. Dis Colon Rectum 1984;27:435–41.
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Read at the meeting of The American College of Gastroenterology, San Francisco, California, October 1990.
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Fleshman, J.W., Dreznik, Z., Meyer, K. et al. Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction. Dis Colon Rectum 35, 1–7 (1992). https://doi.org/10.1007/BF02053330
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DOI: https://doi.org/10.1007/BF02053330