| Objective: As a main intestinal dysfunctions,defecation disorder constipation can result in a series of complications,and has severe impact on the life and work of patients,and which etiology is not explicit.Regular dietary regulation and drug treatment are not better effective or sustainable,and the side effects gradually increase after long-term application.However,the leading research encompass biofeedback therapy and electrical stimulation treatment strategy and so on.which clinical efficacy have been affirmed by many literatures.However,there are still some patients whose symptoms can not be improved,so this study conducted biofeedback plus transanal electrical stimulation therapy to explore its impact on constipation symptom score,patient assessment of constipation quality of life(PAC-QOL),anorectal pressure,sensory threshold indicators.Methods:From August 2017 to October 2018,60 patients with Rome IV functional defecation disorder were prospectively collected from the Colorectal and Anorectal Surgery Clinic of Lu’an Hospital Affiliated to Anhui Medical University.The subjects were divided into three groups randomly : 20 cases in the biofeedback group received biofeedback therapy plus sham transanal electrical stimulation therapy;20 cases in the combined treatment group A underwent cohesive transanal electrical stimulation therapy after biofeedback therapy;and group B underwent cohesive biofeedback therapy after transanal electrical stimulation treatment.Constipation symptom score,PAC-QOL,anorectal resting pressure,rectoanal inhibition reflex,initial perception threshold of rectum,minimum defecation threshold of rectum and maximum tolerable threshold ofrectum were collected at baseline,at the end of treatment and at the end of 3months,respectively.Results:1,Repeated measurement variance analysis of constipation symptom score and PAC-QOL in three groupsConstipation symptom score and PAC-QOL showed significant differences among the three groups(P<0.05).There were all significant differences at the time points of constipation symptom score and PAC-QOL index(P<0.05).Above all indicators had interaction effects between the treatment procedures and time points(P<0.05).2,Simple effect analysis of constipation symptom score and PAC-QOL in three groupsAt baseline,no significant differences in constipation symptom score and PAC-QOL among the three groups were seen(P>0.05).At the end of treatment and at the end of 3 months,significant differences were observed in the above two indicators,comparing the biofeedback group with the comprehensive treatment group A and group B,respectively(P< 0.05);at the end of treatment and at the end of 3 months,tthe constipation symptom score and PAC-QOL were not different between the combined treatment group A and group B(P>0.05).Comparing the above two indicators at baseline with that at the end of treatment and that at the end of 3 months,respectively,significant differences were observed at the comprehensive treatment group A,group B and biofeedback group(P<0.05);the above two indicators at the end of treatment with that at the end of 3 months all did not differ among three groups(P>0.05).3,Repeated measurement variance analysis of anorectal pressure and sensory threshold indicators in three groupsAnorectal resting pressure,primary perception threshold of rectum,minimum defecation threshold of rectum and maximum tolerable threshold of rectum showed obvious differences among the three treatment groups(P<0.05).No significant differences in the rectoanal inhibition reflex among the three groups were seen(P>0.05).There were all significant differences in the time points of pressure and sensory threshold indicators(P<0.05).Above all indicators had interaction effects between the treatment procedures and time points(P<0.05).4,Simple effect analysis of anorectal pressure and sensory threshold indicators in three groupsAt baseline,no significant differences among the three groups in anorectal resting pressure,primary perception threshold of rectum,minimum defecation threshold of rectum and maximum tolerable threshold of rectum were seen(P>0.05).At the end of the treatment and at the end of 3 months,significant differences were observed in the above indicators,comparing the biofeedback group with the comprehensive treatment group A and group B,respectively(P<0.05);at the end of the treatment and at the end of3 months,there was all no significant differences in the above indicators between the comprehensive treatment group A and group B(P>0.05).Comparing the indicators about anorectal pressure and sensory threshold at baseline with that at the end of treatment and that at the end of 3 months,respectively,significant differences were observed at the comprehensive treatment group A,group B and biofeedback group(P<0.05);The indicators of anorectal pressure and sensory threshold at the end of treatment and at the end of 3 months all did not differ among three groups(P>0.05).Conclusion:The symptoms and anorectal physiological changes of constipation patients with defecation disorder are all improved at the three treatment groups,and the short-term efficacy can be maintained stably.Biofeedback combined with transanalelectrical stimulation therapy can significantly improve constipation symptom score,PAC-QOL and rectoanal pressure and sensory threshold,which is notable superior to biofeedback plus sham electrical stimulation procedures,and the sequence of biofeedback treatment and transanal electrical stimulation therapy has not significant impact on the treatment outcomes.The comprehensive therapy can be used as a treatment strategy for constipation with defecation disorder in clinical practice. |
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