title: Pelvic floor dyssynergia: efficacy of biofeedback training.
abstract: OBJECTIVE
  Paradoxical contraction of the pelvic floor during attempts to defaecate is described as pelvic floor dyssynergia (anismus). It is a behavioural disorder (no associated morphological or neurological abnormalities); consequently, biofeedback training has been recommended as a behavioural therapy for such a disorder. The aim of the present study was to evaluate long-term satisfaction of patients diagnosed with pelvic floor dyssynergia after biofeedback.
  
  
  METHODS
  Sixty patients (35 females and 25 males) with a mean age of 30±12years and a 4year duration of constipation were included. Forty-five patients had normal colonic transit and 15 patients had slow colonic transit. History, physical examination and barium enema were done to exclude constipation secondary to organic causes. Colonic and pelvic floor functions (colon-transit time, anorectal manometry, EMG and defaecography) were performed before and after biofeedback treatments. Patients were treated on a weekly basis with an average of (6±2) sessions.
  
  
  RESULTS
  At the end of sessions, 55 out of 60 patients (91.6%) reported a subjectively overall improvement. Symptoms of dyschezia were reported less frequently after biofeedback. Age and gender were not predictive factors of outcome. No symptoms at initial assessment were predictive for patient's satisfaction but the only factor of predictive value was the diagnosis of anismus and the motivated patient who wanted to continue the sessions.
  
  
  CONCLUSIONS
  Biofeedback remains a morbidity free, low-cost and effective outpatient therapy for well-motivated patients complaining of functional constipation and diagnosed as pelvic floor dyssynergia.
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. gadelhak_n_eg@hotmail.com
authors.forename: Nabil
authors.initials: N
authors.lastname: Gadel Hak
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Hemaly
authors.forename: Emad
authors.initials: E
authors.lastname: Hamdy
authors.forename: Ahmed Abd
authors.initials: AA
authors.lastname: El-Raouf
authors.forename: Ehab
authors.initials: E
authors.lastname: Atef
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
authors.forename: Ehab
authors.initials: E
authors.lastname: El-Hanafy
authors.forename: Ahmad
authors.initials: A
authors.lastname: Sultan
authors.forename: Magdy
authors.initials: M
authors.lastname: Haleem
authors.forename: Hala
authors.initials: H
authors.lastname: Hamed
mesh_terms: D000293:Adolescent; D000328:Adult; D001259:Ataxia / Q000628:therapy*; D001676:Biofeedback, Psychology; D003248:Constipation / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009042:Motivation; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult