title: Successful physical therapy for constipation related to puborectalis dyssynergia improves symptom severity and quality of life.
abstract: OBJECTIVE
  This study evaluated symptom severity and quality of life in patients with puborectalis dyssynergia before and after physical therapy.
  
  
  METHODS
  Twenty-two patients with puborectalis dyssynergia were prospectively enrolled into a multidisciplinary program for the treatment of pelvic floor and bowel disorders in this case series. All patients had functional constipation and evidence of puborectalis dyssynergia. Physical therapy and behavioral counseling were offered to all. Patients completed the Patient Health Questionnaire, the Patient-Assessment of Constipation Symptom Questionnaire, and the Patient-Assessment of Constipation Quality of Life Questionnaire.
  
  
  RESULTS
  Sixteen patients successfully completed the program. Symptom severity decreased after physical therapy (2.1 +/- 0.7 vs. 1.3 +/- 0.9, P = 0.007). Quality of life also improved significantly (2.6 +/- 0.8 vs. 1.5 +/- 1.0, P = 0.007). Patients reported less physical discomfort, fewer worries/concerns, and indicated satisfaction with treatment. The difference in symptom severity was highly correlated with improvement in quality of life (r = 0.7, P = .005).
  
  
  CONCLUSIONS
  Successful physical therapy for patients with puborectalis dyssynergia is associated with improvements in constipation-related symptoms and in quality of life.
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0276, USA. clewicky@med.umich.edu
authors.forename: Christina
authors.initials: C
authors.lastname: Lewicky-Gaupp
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Morgan
authors.forename: William D
authors.initials: WD
authors.lastname: Chey
authors.forename: Philip
authors.initials: P
authors.lastname: Muellerleile
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner
mesh_terms: D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000150:complications* / Q000523:psychology; D001259:Ataxia / Q000150:complications* / Q000523:psychology; D003248:Constipation / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome