Anorectal function and the effect of biofeedback therapy in ambulatory spinal cord disease patients having constipation.
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.
Yang
Dong-Hoon
DH
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Myung
Seung-Jae
SJ
Jung
Kee Wook
KW
Yoon
In Ja
IJ
Seo
So Young
SY
Koh
Jung Eun
JE
Yoon
Soon Man
SM
Kim
Kyung Jo
KJ
Ye
Byong Duk
BD
Byeon
Jeong-Sik
JS
Jung
Hwoon-Yong
HY
Yang
Suk-Kyun
SK
Kim
Jin-Ho
JH
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