Bezerra et al., "Use of biofeedback combined with diet for treatment of obstructed defecation associated with paradoxical puborectalis contraction (anismus
): predictive factors and short-term outcome," Diseases of the Colon and Rectum, vol.
, the abnormal contraction of the external anal sphincter and puborectalis muscle during attempted defecation, is another problem that can occur in synergy with constipation in approximately 65% of PD patients, which is more frequently observed during "off" periods [16, 28, 47].
The "'Biofeedback treatment in chronically constipated patients with dyssynergic defecation", article aimed to evaluate the effects of psychophysiological measures (EMG-activity during straining to defecate and anismus
index), as well as in clinical variables on chronically constipated patients with dyssynergic defecation.
However, the most common of the evacuatory disorders is pelvic floor dysfunction or anismus
. This results from inco-ordination or spasm of the puborectalis muscle.
Whether or not resolving these issues will solve constipation, it is fundamental to start here when there is no evidence of obstruction, impaction or anismus.
Behavioral therapy with biofeedback may yield some success with anismus, as well as reducing the effects of stress in general.
Outlet obstruction constipation (anismus
) managed by biofeedback.
Roughly 50% of all cases of chronic constipation are due to a failure of coordination between the pelvic floor muscles and the anal sphincter--a condition called dyssynergic defecation or anismus
There are many different diagnoses associated with CPP including vulvar pain syndromes, interstitial cystitis, levator ani syndrome, piriformis syndrome, vaginismus, anismus
, dyspareunia, proctalgia fugax, constipation, pelvic floor tension myalgias, endometriosis, pudendal neuralgia, and/or rectal pain.
They concluded that treatment of the rectocele is not necessary once the abnormality has been corrected, such as intrarectal prolapse or anismus
. Other studies suggest that while rectocele may contribute to constipation or difficult defecation other possibilities should be eliminated before surgical repair is attempted.[38,39]
Established contraindications include anismus
, POP with or without enterocele, and impaired efficiency in anal closing mechanism.
Los resultados muestran mejoras significativas en las medidas psicofisiologicas (actividad-EMG durante el esfuerzo para defecar e indice de anismus
), asi como en las variables clinicas.