title: Use of Biofeedback Combined With Diet for Treatment of Obstructed Defecation Associated With Paradoxical Puborectalis Contraction (Anismus): Predictive Factors and Short-term Outcome.
abstract: BACKGROUND
  Numerous studies have described the use of biofeedback therapy for the treatment of anismus. Success rates vary widely, but few data are available regarding factors predictive of success.
  
  
  OBJECTIVE
  Our aim was to evaluate short-term results of biofeedback associated with diet in patients with obstructed defecation because of anismus and to investigate factors that may affect the results.
  
  
  METHODS
  Patients were identified from a single-institution prospectively maintained database.
  
  
  METHODS
  This study was conducted in a tertiary hospital.
  
  
  METHODS
  Consecutive patients who had obstructed defecation associated with anismus and were treated with biofeedback associated with diet were eligible.
  
  
  METHODS
  Each patient underwent anal manometry and/or dynamic anal ultrasound. Patients with anismus and were treated with biofeedback associated with diet.
  
  
  METHODS
  Patients classed as having a satisfactory response to therapy and those classed as having an unsatisfactory response were compared with regard to sex, age, Cleveland Clinic Florida constipation score, functional factors (anal resting and squeeze pressures and reversal of paradoxical puborectalis contraction on manometry), and anatomic factors in women (history of vaginal delivery, number of vaginal deliveries, menopause, hysterectomy, and previous anorectal surgery).
  
  
  RESULTS
  A total of 116 patients were included (75 women and 41 men). Overall, 59% were classed as having a satisfactory response (decrease in constipation score, >50%). Patients with satisfactory responses to biofeedback plus diet did not differ from those with unsatisfactory responses with regard to clinical, anatomic, and physiological factors.
  
  
  CONCLUSIONS
  This was not a randomized controlled trial.
  
  
  CONCLUSIONS
  Biofeedback combined with diet is a valuable treatment option for patients with obstructed defecation syndrome associated with anismus, and more than half of our patients of both sexes achieved a satisfactory response. Improvement was not related to reversal of paradoxical contraction of puborectalis muscles at manometry. Patient sex, age, previous anorectal surgery, anorectal manometry pressures, and vaginal delivery, menopause, and hysterectomy in women did not significantly affect outcome.
authors.affiliation: 1 Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Ceará, Brazil 2 Unit of Pelvic Floor and Anorectal Physiology, Clinical Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil 3 Unit of Pelvic Floor and Anorectal Physiology, Department of Colorectal Surgery, Sao Carlos Hospital, Ceará, Brazil.
authors.forename: Sthela M
authors.initials: SM
authors.lastname: Murad-Regadas
authors.forename: Francisco S Pinheiro
authors.initials: FS
authors.lastname: Regadas
authors.forename: Carla C Rocha
authors.initials: CC
authors.lastname: Bezerra
authors.forename: Maura T Coutinho Cajazeiras
authors.initials: MT
authors.lastname: de Oliveira
authors.forename: Francisco S Pinheiro
authors.initials: FS
authors.lastname: Regadas Filho
authors.forename: Lusmar Veras
authors.initials: LV
authors.lastname: Rodrigues
authors.forename: Saulo Santiago
authors.initials: SS
authors.lastname: Almeida
authors.forename: Graziela O
authors.initials: GO
authors.lastname: da Silva Fernandes
mesh_terms: D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D001676:Biofeedback, Psychology / Q000379:methods*; D001938:Brazil; D003248:Constipation / Q000150:complications / Q000178:diet therapy / Q000503:physiopathology / Q000628:therapy; D016208:Databases, Factual; D003672:Defecation / Q000187:drug effects / Q000502:physiology; D004043:Dietary Fiber / Q000627:therapeutic use; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage*; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D017773:Pelvic Floor / Q000503:physiopathology; D012007:Rectum / Q000503:physiopathology; D012737:Sex Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D004043:Dietary Fiber; D054368:Laxatives