title: Abdominal Symptoms Are Common and Benefit from Biofeedback Therapy in Patients with Dyssynergic Defecation.
abstract: OBJECTIVE
  Dyssynergic defecation (DD) is a subtype of chronic constipation that responds to biofeedback therapy (BFT). Abdominal, anorectal, and stool symptoms are commonly reported by DD patients, but limited data exist to demonstrate the improvement of these associated symptoms to BFT. Aims to prospectively study the response of constipation and associated abdominal, rectal, and stool symptoms to biofeedback in a population with dyssynergia.
  
  
  METHODS
  Patients with DD as determined by anorectal manometry and balloon expulsion testing were included into the study. All patients completed a validated survey, the Personal Assessment of Constipation Symptom (PAC-SYM) questionnaire, before and following BFT. The PAC-SYM is a clinical tool to assess constipation-related symptom frequency and severity.
  
  
  RESULTS
  Seventy-seven dyssynergic patients fulfilled the study requirements. Abdominal symptoms were present in up to 74% of patients with dyssynergia. PAC-SYM summation scores improved following completion of biofeedback by 48%, from 22.08 to 11.48 (P<0.001). The proportion of patients with at least moderate symptoms decreased in all 12 questionnaire items, including all abdominal symptoms, after completing BFT (46.8% to 14.3%, P<0.001).
  
  
  CONCLUSIONS
  Abdominal symptoms are common in patients with dyssynergia. BFT improves both anorectal-related constipation symptoms and associated abdominal symptoms in patients with DD. Limitations of this study are observational design, lack of control group, and lack of long-term follow-up.
authors.affiliation: 1] Michigan Bowel Control Program, University of Michigan Health System, Ann Arbor, Michigan, USA [2] Gastrointestinal Physiology Laboratory Coordinator, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Baker
authors.affiliation: 1] Michigan Bowel Control Program, University of Michigan Health System, Ann Arbor, Michigan, USA [2] University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Shanti
authors.initials: S
authors.lastname: Eswaran
authors.affiliation: 1] Michigan Bowel Control Program, University of Michigan Health System, Ann Arbor, Michigan, USA [2] University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Saad
authors.affiliation: 1] Michigan Bowel Control Program, University of Michigan Health System, Ann Arbor, Michigan, USA [2] University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Menees
authors.affiliation: 1] Michigan Bowel Control Program, University of Michigan Health System, Ann Arbor, Michigan, USA [2] Department of Physical Medicine and Rehabilitation, University of Michigan Hospital, Ann Arbor, Michigan, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shifferd
authors.affiliation: 1] Michigan Bowel Control Program, University of Michigan Health System, Ann Arbor, Michigan, USA [2] Department of Physical Medicine and Rehabilitation, University of Michigan Hospital, Ann Arbor, Michigan, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Erickson
authors.affiliation: 1] Michigan Bowel Control Program, University of Michigan Health System, Ann Arbor, Michigan, USA [2] Department of Physical Medicine and Rehabilitation, University of Michigan Hospital, Ann Arbor, Michigan, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Barthelemy
authors.affiliation: 1] Michigan Bowel Control Program, University of Michigan Health System, Ann Arbor, Michigan, USA [2] University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Chey