title: Anorectal function and the effect of biofeedback therapy in ambulatory spinal cord disease patients having constipation.
abstract: OBJECTIVE
  Constipation in patients with mild spinal cord disease is not well investigated yet. We aimed to investigate anorectal function and the effect of biofeedback therapy in constipated patients with mild spinal cord diseases.
  
  
  METHODS
  A total of 14 constipated patients with myelopathy and 32 with radiculopathy were enrolled retrospectively. All patients were able to walk independently. The control group comprised of 100 constipated patients without any neurologic problem. Colonic transit time and the presence of dyssynergia were assessed before biofeedback therapy. All patients answered structured questionnaires on constipation, before and after biofeedback therapy.
  
  
  RESULTS
  The mean rectosigmoid colonic transit time of the myelopathy group was significantly delayed (myelopathy, 18.6 ± 14.6 h; radiculopathy, 12.8 ± 11.9 h; control, 9.6 ± 11.2 h; p = 0.032). Delay in total colonic transit time was more frequent in the myelopathy group (myelopathy, 57.1%; radiculopathy, 23.3%; control, 18.5%; p = 0.004). On anorectal manometry, the squeezing pressure of the anal sphincter was decreased in the myelopathy group (myelopathy, 132.3 ± 73.3 mmHg; radiculopathy, 179.9 ± 86.1 mmHg; control 200.4 ± 82.4 mmHg; p < 0.05). The success rate of biofeedback therapy was lower in the myelopathy group (28.6% for myelopathy vs. 62.0% for control group; p = 0.034). The response rate to biofeedback therapy was similar between radiculopathy and control group (62.5% for radiculopathy vs. 62.0% for control group; p = 1.000).
  
  
  CONCLUSIONS
  In constipation associated with mild myelopathy, delayed colonic transit and dyssynergic defecation were major pathophysiologic abnormalities and biofeedback was less effective compared with control group. However, in the radiculopathy group, biofeedback was as effective as in the control group.
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Yang
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Myung
authors.forename: Kee Wook
authors.initials: KW
authors.lastname: Jung
authors.forename: In Ja
authors.initials: IJ
authors.lastname: Yoon
authors.forename: So Young
authors.initials: SY
authors.lastname: Seo
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Koh
authors.forename: Soon Man
authors.initials: SM
authors.lastname: Yoon
authors.forename: Kyung Jo
authors.initials: KJ
authors.lastname: Kim
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D001003:Anal Canal / Q000503:physiopathology*; D001676:Biofeedback, Psychology / Q000379:methods*; D003248:Constipation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003672:Defecation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010045:Outpatients; D011312:Pressure; D012007:Rectum / Q000503:physiopathology*; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome