Anorectal Motility, Rectal Sensation, Psychological Condition And Biofeedback On Functional Constipation

Background:Functional constipation (FC) is one kind of common gastrointestinal disease.Accordng toAGA, four types of FC were divided:normal transit constipation(NTC),slow transit constipation(STC),outlet obstructive constipation(OOC),and mixed typeconstipation(MC).The preva1ence of FC varies from 4 to l7 percent in ordinarypeople with the genera1 tendency that it is more common in the West than in theEast,in female than in male, and in the old than in the young according to thedomestic and international related reports. What deserves to be noticed is that themorbidity of young people has been rising up too. The studies on FC have attractedmuch attention with the growing number of its patients day by day because it hasbecome increasinglyharmful to human beings.So far, the pathogen and the mechanism of FC are not all clear yet. Recent research suggested that physiological and psychological problems often coexist inpatients with constipation. Recently, study on pelvic bottom function obstacle andbrain-gut axis is considered most promising. Biofeedback training is a newpsychological treatment, which improves symptoms greatly. However, few study onimproving pelvic bottom function and psychological condition bybiofeedback.This paper is to explore the difference of anorectal motility, rectal sensation, andpsychological condition among types of FC, analyze the relationship betweenanorectal function and psychological condition, and investigate the mechanism ofbiofeedback.Objectives:1. To explore the difference of anorectal motility, rectal sensation, andpsychological condition among types of FC.2. To analyze the relationship between anorectal function and psychologicalcondition.3. To investigate the mechanism of biofeedback on anorectal motility andpsychological condition.Materials and Methods:1. Seventy-one FC patients were categorized according to Colon transittime(CTT) and Transit index(TI). Thirty healthy people were included as controls.Anorectal manometry and Zung'self-rating anxiety scales (SAS) and self-ratingdepressive scales (SDS) for psychological condition were carried out in all subjects toinvestigate the anorectal motility, rectal sensation and psychological condition inpatients and the controls.And the relationship between psychological condition andanorectal function was also analized. 2. Sixty patients were received biofeedback training. After accomplishingtreatment, assess clinical symptoms, SAS, SDS, and anorectal motility again.Statistics and analyses the parameters before and after biofeedback.Results:1. FC patients showed abnormal anorectal motility and sensation. Comparedwith controls, FC patients had lower anal resting pressure (P<0.05), higher firstdefecation sensation, defecation thresholds and maximal volume of tolerance(P<0.01).2. Four types of FC displayed different anorectal characteristic. NTC type hadlower anal resting pressure (P<0.05), higher first defecation sensation, defecationthresholds and maximal volume of tolerance (P<0.01). OOC type had higher firstdefecation sensation, defecation thresholds and maximal volume of tolerance(P<0.01). STC had higher maximal volume of tolerance (P<0.05). MC had nosignificant difference among them (P>0.05).Compared with each type, NTC and OOC both showed higher first sensationthan STC and MC (P<0.05).3. Patients with FC present poor psychological health: The SAS and SDSscores were significantly higher in FC patients than those in controls (40.99±9.79 vs.28.75±4.09,51.46±11.58 vs. 32.67±7.17,P<0.01).4. Anorectal function of patients was associated with anxiety and depression.SAS and SDS were negative related to squeezing pressure, and were positive relatedto first defecation sensation, defecation thresholds and maximal volume of tolerance(P<0.05).5. After biofeedback training, clinical symptom was greatly improved: 71.7%(43/60)of patients were greatlyeffective, 18.3%(11/60)of patients were effective, the total effective rate was 90.0%, and the total satisfaction was 96.7%.6. After biofeedback training, FC patients improved their psychologicalcondition (P<0.01).7. As to 36 FC patients who received anorectal manometry before and afterbiofeedback, we didn't found anysignificant difference between them.Conclusions:FC patients have abnormal anorectal function that correlated to anxiety anddepression, which maybe induce FC.Biofeedback training can effectively improve not only clinical symptoms butalso their psychological condition. But it is also need further investigation onanorectal function.