Abstract
Background
Rehabilitation is the first therapeutic step of obstructed defecation, after failure of conservative therapy with high-fiber diet and laxatives. This study evaluates the usefulness of psyllium, a bulk-forming agent, when used during rehabilitation of obstructed defecation.
Methods
Between January 2008 and December 2010, 45 patients affected by obstructed defecation were included in the study. Two randomized groups were selected. Group 1 (21 women; age range 25–67 (mean, 51.8) years) continued to consume a high-fiber diet (approximately 30 g fiber per day) during rehabilitation. Group 2 (24 women; age range 46–71 (mean, 59.8) years) consumed only psyllium (3.6 g × 2/day; Psyllogel® Fibra, Nathura, Montecchio Emilia, Italy) during the rehabilitative cycle. After a preliminary clinical evaluation, including the obstructed defecation syndrome (ODS) score, patients underwent defecography and anorectal manometry as well as rehabilitative treatment according to the “multimodal rehabilitative program” for obstructive defecation. At the end of the program, patients were reassessed by clinical evaluation and anorectal manometry. Post-rehabilitative ODS scores were used for an arbitrary schedule of patients divided into three classes: Class I, good (score ≤ 4); Class II, fair (score > 4 to ≤ 8); Class III, poor (score > 8).
Results
The number of bowel movements per week did not increase significantly after rehabilitation. Both groups had a significantly better Bristol stool form scale score (Group 1: P < 0.034; Group 2: P < 0.02). The overall mean ODS score from Groups 1 and 2 showed significant improvement after treatment (P < 0.001). Twenty-eight patients (82.3%) were Class I (good results) without significant differences between groups. Nine women were symptom-free. Significant differences were found between pre-rehabilitative and post-rehabilitative manometric data from the straining test (P < 0.001) and duration of maximal voluntary contraction (Group 1: P < 0.004; Group 2: P < 0.02). A significant difference was found between the pre-rehabilitative and post-rehabilitative conscious rectal sensitivity threshold (CRST) in Group 2 women (P < 0.02). The Group 2 women who underwent volumetric rehabilitation (11 patients) had significantly lower post-rehabilitative CRST values than pre-rehabilitative values (P < 0.002); the length of volumetric rehabilitation was also significantly shorter in Group 2 patients (P < 0.04) than in Group 1 patients.
Conclusions
After rehabilitation of obstructed defecation, some patients became symptom-free and many had an improved ODS score. Psyllium is helpful for volumetric rehabilitation: patients who consumed psyllium had lower post-rehabilitative CRST values than subjects were on high-fiber diet.
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References
Singh B (2007) Psyllium as therapeutic and drug delivery agent. Int J Pharm 334:1–14
Bouchoucha M, Faye A, Savarieau B, Arsac M (2004) Effect of an oral bulking agent and a rectal laxative administered alone or in combination for the treatment of constipation. Gastroenterol Clin Biol 28:438–443
Ramkumar D, Rao SS (2005) Efficacy and safety of traditional medical therapy for chronic constipation: systematic review. Am J Gastroenterol 100:936–971
Andromanakos N, Skandalakis P, Troupis T, Filippou D (2006) Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 21:638–646
Pucciani F, Magali R, Ringressi MN (2011) Obstructed defecation: what is the role of rehabilitation? Colorectal Dis. doi:10.1111/j.1463-1318.2011.02644.x
O’Donnell LJ, Virjee J, Heaton KW (1988) Pseudo-diarrhoea in the irritable bowel syndrome: patients’ records of stool form reflect transit time while stool frequency does not. Gut 29:A1455
Bharucha AE, Wald A, Enck P, Rao S (2006) Functional anorectal disorders. Gastroenterology 130:1510–1518
Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10:84–88
Piloni V, Genovesi N, Grassi R, Lazzini S, Pieri L, Pomerri F (1993) National working team report on defecography. Radiol Med 85:784–793
Pucciani F, Rottoli ML, Bologna A et al (1996) Anterior rectocele and anorectal dysfunction. Int J Colorectal Dis 11:1–9
Martelli H, Devroede G, Arhan P, Duguay C, Dornic C, Faverdin C (1978) Some parameters of large bowel motility in normal man. Gastroenterology 75:612–618
Pucciani F, Rottoli ML, Bologna A et al (1998) Pelvic floor dyssynergia and bimodal rehabilitation: results of combined pelviperineal kinesitherapy and biofeedback training. Int J Colorectal Dis 13:124–130
Pucciani F, Ringressi MN, Redditi S, Masi A, Giani I (2008) Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results. Dis Colon Rectum 51:1552–1558
Khaikin M, Wexner SD (2006) Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol 12:3168–3173
Camilleri M, Bharucha AE (2010) Behavioural and new pharmacological treatments for constipation: getting the balance right. Gut 59:1288–1296
Chiarioni G, Heymen S, Whitehead WE (2006) Biofeedback therapy for dyssynergic defecation. World J Gastroenterol 12:7069–7074
Heymen S, Jones KR, Scarlett Y, Whitehead WE (2003) Biofeedback treatment of constipation: a critical review. Dis Colon Rectum 46:1208–1217
Palsson OS, Heymen S, Whitehead WE (2004) Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback 29:153–174
Koh CE, Young CJ, Young JM, Solomon MJ (2008) Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. Br J Surg 95:1079–1087
Cheskin LJ, Kamal N, Crowell MD, Schuster MM, Whitehead WE (1995) Mechanisms of constipation in older persons and effects of fiber compared with placebo. J Am Geriatr Soc 43:666–669
Attaluri A, Donahoe R, Valestin J, Brown K, Rao SS (2011) Randomised clinical trial: dried plums (prunes) vs psyllium for constipation. Aliment Pharmacol Ther 33:822–828
Stevens J, VanSoest PJ, Robertson JB, Levitsky DA (1988) Comparison of the effects of Psyllium and wheat bran on gastrointestinal transit time and stool characteristics. J Am Diet Assoc 88:323–326
Marteau P, Flourié B, Cherbut C et al (1994) Digestibility and bulking effect of ispaghula husks in healthy humans. Gut 35:1747–1752
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The authors declare that they have no actual or potential conflict of interest related to the publication of this article.
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Pucciani, F., Raggioli, M. & Ringressi, M.N. Usefulness of psyllium in rehabilitation of obstructed defecation. Tech Coloproctol 15, 377–383 (2011). https://doi.org/10.1007/s10151-011-0722-4
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DOI: https://doi.org/10.1007/s10151-011-0722-4