title: Biofeedback therapy for female patients with constipation caused by radical hysterectomy or vaginal delivery.
abstract: OBJECTIVE
  Chronic constipation is frequently seen in women who have undergone hysterectomy or delivery. However, reports regarding anorectal physiologic features in those patients are rare. Patients with constipation associated with either radical hysterectomy or vaginal delivery were analyzed in order to clarify the anorectal physiologic features and the effectiveness of biofeedback therapy.
  
  
  METHODS
  Of the constipated patients, a hysterectomy group (n = 40), delivery group (n = 41), and a control group (n = 89), who had no history of either surgery or delivery before developing functional constipation were included. Their anorectal physiological tests and the effectiveness of biofeedback therapy were investigated.
  
  
  RESULTS
  The volume of desire to defecate was greater in the hysterectomy group than in the control group (86.5 ± 55.0 mL vs 62.9 ± 33.7 mL; P = 0.03), and more than 240 mL of maximal volume of toleration was more frequently noted in the hysterectomy group (32.5%) than in the delivery group (14.6%) and control group (13.5%) (P = 0.02).The failure of balloon expulsion was more frequently noted in the delivery group (44.0%) than in the hysterectomy group (15.0%) and control group (25.0%) (P = 0.01). The defecation satisfaction score was significantly increased after biofeedback therapy in the hysterectomy group (2.0 ± 2.7 vs 7.8 ± 1.5, P < 0.001), the delivery group (1.6 ± 2.1 vs 6.7 ± 2.0, P < 0.001), and the control group (2.5 ± 2.7 vs 6.9 ± 2.1, P < 0.001).
  
  
  CONCLUSIONS
  Rectal hyposensitivity could have been the characteristic mechanism in the hysterectomy group, whereas dyssynergic defecation could have been the cause in the delivery group. Biofeedback therapy was effective for both groups.
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors: Soo-Kyung
authors: SK
authors: Park
authors: Seung-Jae
authors: SJ
authors: Myung
authors: Kee Wook
authors: KW
authors: Jung
authors: Yoon Hee
authors: YH
authors: Chun
authors: Dong-Hoon
authors: DH
authors: Yang
authors: So-Young
authors: SY
authors: Seo
authors: Hyun-Sook
authors: HS
authors: Ku
authors: In Ja
authors: IJ
authors: Yoon
authors: Kyung Jo
authors: KJ
authors: Kim
authors: Byong Duk
authors: BD
authors: Ye
authors: Jeong-Sik
authors: JS
authors: Byeon
authors: Hwoon-Yong
authors: HY
authors: Jung
authors: Suk-Kyun
authors: SK
authors: Yang
authors: Jin-Ho
authors: JH
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology; D001676:Biofeedback, Psychology / Q000379:methods*; D003248:Constipation / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D003672:Defecation / Q000502:physiology; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology