Functional constipation is a common clinical presentation in primary care.
Functional defecation disorders are defined as the paradoxical contraction or inadequate relaxation of the pelvic floor muscles during attempted defecation and/or inadequate propulsive forces during attempted defecation.
Prompt diagnosis and management of dyssynergic defecation is hindered by uncertainty regarding nomenclature, diagnostic criteria, pathophysiology and efficacy of management options such as biofeedback therapy.
Dr Burgell and colleagues from Australia reviewed the evidence pertaining to the pathophysiology of functional defecation disorders and the efficacy of biofeedback therapy in the management of patients with dyssynergic defecation and functional constipation.
Relevant articles addressing functional defaecation disorders and the efficacy of biofeedback therapy in the management of dyssynergic defaecation and functional constipation were identified from a search of Pubmed, MEDLINE Ovid and the Cochrane Library.
|Long-term studies have shown 55%-82% of patients maintain symptom improvement|
|Alimentary Pharmacology & Therapeutics|
The team found that the prevalence of dyssynergic defecation in patients investigated for chronic constipation is as many as 40%.
Randomized controlled trials have demonstrated major symptom improvement in 70%-80% of patients undergoing biofeedback therapy for chronic constipation resistant to standard medical therapy and have determined it to be superior to polyethylene glycol laxatives, diazepam or sham therapy.
Long-term studies have shown 55%-82% of patients maintain symptom improvement.
Dr Burgell's team concludes, "Dyssynergic defecation is a common clinical condition in patients with chronic constipation not responding to conservative management."
"Biofeedback therapy appears to be a safe, successful treatment with sustained results for patients with dyssynergic defecation."
"Further studies are required to standardise the diagnosis of dyssynergic defecation in addition to employing systematic protocols for biofeedback therapy."