title: Psycho-echo-biofeedback: a novel treatment for anismus--results of a prospective controlled study.
abstract: BACKGROUND
  Anismus or non-relaxing puborectalis muscle (PRM), detectable with anal/vaginal ultrasound (US), is a cause of obstructed defecation (OD) and may be treated with biofeedback (BFB). Many patients with anismus are anxious and/or depressed. The aim of this prospective study was to evaluate the outcome of the novel procedure psycho-echo-BFB in patients with anismus and psychological disorders.
  
  
  METHODS
  Patients presenting at our unit with anismus and psychological disorders between January 2009 and December 2013, and not responding to conventional conservative treatment, were enrolled in the study. All underwent four sessions of psycho-echo-BFB, carried out by two psychologists and a coloproctologist, consisting of guided imagery, relaxation techniques and anal/vaginal US-assisted BFB. A validated score for OD was used, and PRM relaxation on straining measured before and after the treatment. PRM relaxation was also measured in a control group of 7 patients with normal bowel habits.
  
  
  RESULTS
  Ten patients (8 females, median age 47 years, range 26-72 years) underwent psycho-echo-BFB. The OD score, evaluated prior to and at a median of 25 months (range 1-52 months) after the treatment, improved in 7 out of 10 patients, from 13.5 ± 1.2 to 9.6 ± 2.2 (mean ± standard error of the mean (SEM)), p = 0.06. At the end of the last session, PRM relaxed on straining in all cases, from 0 to 7.1 ± 1.1 mm, i.e., physiological values, not statistically different from those of controls (6.6 ± 1.5 mm). Two patients reported were cured, 3 improved and 5, all of whom had undergone prior anorectal surgery, unchanged. No side effects were reported.
  
  
  CONCLUSIONS
  Psycho-echo-BFB is safe and inexpensive and allows all patients with anismus to relax PRM on straining. Previous anorectal surgery may be a negative predictor.
authors.affiliation: Coloproctology Unit, Parioli Clinic, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Del Popolo
authors.forename: V M
authors.initials: VM
authors.lastname: Cioli
authors.forename: T
authors.initials: T
authors.lastname: Plevi
authors.forename: M
authors.initials: M
authors.lastname: Pescatori
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D001004:Anus Diseases / Q000150:complications / Q000523:psychology / Q000628:therapy*; D001008:Anxiety Disorders / Q000150:complications / Q000628:therapy; D001676:Biofeedback, Psychology / Q000379:methods*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D003248:Constipation / Q000209:etiology; D003672:Defecation / Q000502:physiology; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009126:Muscle Relaxation / Q000502:physiology; D017773:Pelvic Floor; D059952:Pelvic Floor Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy; D011446:Prospective Studies; D016896:Treatment Outcome