Defecation function and quality of life in patients with slow-transit constipation after colectomy

BACKGROUND Although total or subtotal colectomy for slow-transit constipation(STC)has been proven to be a definite treatment,the associated defecation function and quality of life(QOL)are rarely studied.AIM To evaluate the effectiveness of surgery for STC regarding defecation function and QOL.METHODS From March 2013 to September 2017,30 patients undergoing surgery for STC in our department were analyzed.Preoperative,intra-operative,and postoperative 3-mo,6-mo,1-year,and 2-year follow-up details were recorded.Defecation function was assessed by bowel movements,abdominal pain,bloating,straining,laxative,enema use,diarrhea,and the Wexner constipation and incontinence scales.QOL was evaluated using the gastrointestinal QOL index and the 36-item short form survey.RESULTS The majority of patients(93.1%,27/29)stated that they benefited from the operation at the 2-year follow-up.At each time point of the follow-up,the number of bowel movements per week significantly increased compared with that of the preoperative conditions(P<0.05).Similarly,compared with the preoperative values,a marked decline was observed in bloating,straining,laxative,and enema use at each time point of the follow-up(P<0.05).Postoperative diarrhea could be controlled effectively and notably improved at the 2-year follow-up.The Wexner incontinence scores at 6-mo,1-year,and 2-year were notably lower than those at the 3-mo follow-up(P<0.05).Compared with those of the preoperative findings,the Wexner constipation scores significantly decreased following surgery(P<0.05).Thus,it was reasonable to find that the gastrointestinal QOL index scores clearly increase(P<0.05)and that the 36-item short form survey results displayed considerable improvements in six spheres(role physical,role emotional,physical pain,vitality,mental health,and general health)following surgery.CONCLUSION Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients’QOL.

Effectiveness of Electro-acupuncture Combined with Biofeedback in Patients with Functional Defecation Disorder:A Meta-analysis

Objective:To systematically evaluate and compare the effects of electro-acupuncture combined with biofeedback training and simple biofeedback training on the intervention of patients with functional defecation disorder.Methods:Computer retrieval was performed to search randomized controlled trials about electroacupuncture combined with biofeedback training in the treatment of patients with functional defecation disoder from January 2000 to January 2019 via websites,including CNKI,Wanfang data knowledge service platform,CBM,VIP,Pub Med,EMBase,Cochrane Library,Web of Science,and Springerlink,JBI evidence-based Nursing database,RNAO,Nursing Consult,BIOSIS,Medline and so on.Screening was performed according to the inclusion and exclusion criteria,data were extracted,literature quality was evaluated,and Meta analysis was performed on the extracted data using Rev Man5.3 software.Results:Five studies including 363 subjects were included.The results of meta-analysis showed that the effective rate of electroacupuncture combined with biofeedback group(combined group)in the treatment of functional defecation disorder was higher than that of biofeedback group(control group)[RR=1.29,95%CI(1.17,1.42),P<0.00001],the difficulty score of defecation in combined group was lower than that of control group[MD=–0.71,95%CI(–1.22,–0.21),P=0.006],and anal rest pressure was lower than that of control group[MD=–0.44,95%CI(-0.80,–0.09),P=0.02].Tubing maximum systolic pressure is lower than the control group[MD=–2.06,95%CI(–3.60,–0.52),P=0.009).Conclusion:Acupuncture combined with biofeedback can effectively improve the defecation difficulty of patients with functional defecation disorder,as well as the anal resting pressure and the maximum anal systolic pressure.Due to the limitation of the number of included literatures and the heterogeneity among evaluation indexes,the evaluation of defecation difficulty score and anal dynamics still needs to be further evaluated under the support of clinical studies with more centers,high quality and large sample size.

Biofeedback therapy for dyssynergic defecation

Dyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. This is believed to be a behavioral disorder because there.are no associated morphological or neurological abnormalities, and consequently biofeedback training has been recommended for treatment. Biofeedback involves the use of pressure measurements or averaged electromyographic activity within the anal canal to teach patients how to relax pelvic floor muscles when straining to defecate. This is often combined with teaching the patient more appropriate techniques for straining （increasing intra-abdominal pressure） and having the patient practice defecating a water filled balloon. Tn adults, randomized controlled trials show that this form of biofeedback is more effective than laxatives, general muscle relaxation exercises （described as sham biofeedback）, and drugs to relax skeletal muscles. Moreover, its effectiveness is specific to patients who have dyssynergic defecation and not slow transit constipation. However, in children, no clear superiority for biofeedback compared to laxatives has been demonstrated. Based on three randomized controlled studies in the last two years, biofeedback appears to be the preferred treatment for dyssynergic defecation in adults.

Using Gluteus Maximus Muscle to Reconstruct the Anal Sphincter for Very Low Rectal Cancer

OBJECTIVE To assess the use of gluteus maximus muscle to recon- struct the anal sphincter for very low rectal cancer. This study aimed to evaluate the local recurrence and function of the new anal sphincter after operation. METHODS Sixteen patients underwent the replacement operation, and then received biofeedback treatments 1 month after the operation. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. The controls were 30 cases who had undergone a low anterior resection for rectal cancer and 30 healthy people. RESULTS Median follow-up was 4.2 years. No local recurrence was observed. The Vaizey and Wexner scores and vectorial manometry 1 month after operation were significantly lower than those of the healthy and low anterior resection controls （ P 〈0.001） . After biofeedback treatments, the above indexes improved significantly （ P 〈0.001）, especially after 1 year （ P 〈0.001）, but still remained lower than the controls（ P 〈0.001）. The rectoanal reflex only increased to 31.3 % 1 year after operation. CONCLUSION The local recurrence after the replacement operation was low. The defecation function was poor early after operation, but increased markedly after biofeedback treatments and long-term functional exercise. This therapy can be one choice for very low rectal cancer.

Effects of Acupuncture on the Constipation in Rats Model

Objective： To investigate the effects of acupuncture on constipation in rats. Method： Compound diphenoxylate was used to set up rat model of constipation. After needling “Hegu” and “Housanli”, the time to first bowel movement, and stool grains quantity and weight in 12 rats were observed. Results： The time to first bowel movement was delayed, and the stool grains quantity and weight were reduced in the model rats. Acupuncture could significantly shorten the time to first bowel movement, and increase stool grains quantity and weight. Conclusion： Acuouncture can imorove the defecating abilities in rats model ofconstioation.