title: MR defecography: a diagnostic test for the evaluation of pelvic floor motion in patients with dyssynergic defecation after biofeedback therapy.
abstract: BACKGROUND
  Dyssynergic defecation is a major cause of chronic functional constipation as a common digestive complaint. We clinically evaluated the effects of biofeedback therapy on the pelvic floor motion indices through magnetic resonance (MR) defecography, quality of life and depression in patients with dyssynergic defecation.
  
  
  METHODS
  In this clinical trial study, among patients referring to the Colorectal Clinic of Hazrat Rasoul Hospital, 22 subjects were randomly assigned into two equal groups (n= 11) to receive either standard only or biofeedback and standard therapy. Dynamic changes of the pelvic floor were measured by MR defecography. During the simulated defecation, two MR defecography dynamic indices including abnormal anorectal angle change and perineal descent were measured before and after treatment. The effects of biofeedback therapy on patients' symptoms, quality of life and severity of depression were assessed and compared with the standard therapy. Statistical analysis was carried out using independent _t-test and Mann-Whitney test.
  
  
  RESULTS
  Paradox index (p< 0.001), perineal descent index (p< 0.001), depression (p< 0.1), physical function (p< 0.001), vitality (p< 0.001) and role emotion (p< 0.001) significantly improved in the biofeedback therapy group in contrast to the standard therapy SDT group.
  
  
  CONCLUSIONS
  Biofeedback therapy appears to be effective in improving symptoms of functional constipation and dysfunction of pelvic floor motion as well as patient's quality of life and depression state. MR defecography is able to show the changes in dynamic indices of the pelvic floor through biofeedback therapy.
authors.affiliation: PhD Candidate, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. afsanehnikjooy@yahoo.com.
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Nikjooy
authors.affiliation: Associate Professor, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. maroufi.n@iums.ac.ir.
authors.forename: Nader
authors.initials: N
authors.lastname: Maroufi
authors.affiliation: Professor, Department of Physiotherapy, School of Rehabilitation, Sciences, Iran University of Medical Sciences, Tehran, Iran. ebrahimi.pt@gmail.com.
authors.forename: Ismaeil
authors.initials: I
authors.lastname: Ebrahimi Takamjani
authors.affiliation: Assistant Professor, Babak imaging Center, & Department of Radiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. drhhh_kharazi@yahoo.com.sg.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Hadizdeh Kharazi
authors.affiliation: Associate Professor, Surgery Department, Colorectal Research Center (CRRC) Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. bahar1167@yahoo.com.
authors.forename: Bahar
authors.initials: B
authors.lastname: Mahjoubi
authors.affiliation: Assistant Professor, Colorectal Surgery Department, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. razizimd@hotmail.com.
authors.forename: Rasoul
authors.initials: R
authors.lastname: Azizi
authors.affiliation: Assistant Professor, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. haghani511@yahoo.com.
authors.forename: Hamid
authors.initials: H
authors.lastname: Haghani
keywords: Biofeedback Therapy; Dyssynergic Defecation; Functional Constipation; MR Defecography