Pattern Analysis of Defecography in Patients with Chronic Functional Constipation: Is It Predictable for the Responsiveness of Biofeedback Therapy?.
10.3348/jkrs.2005.53.2.95
- Author:
Hye Rin YANG
1
;
Ah Young KIM
;
Seong Sook HONG
;
Jae Ho BYUN
;
Seung Jae MYUNG
;
Hyun Kwon HA
Author Information
1. Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea. aykim@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Defecography;
Rectum, radiography
- MeSH:
Anal Canal;
Biofeedback, Psychology*;
Constipation*;
Defecation;
Defecography*;
Humans;
Muscle Spasticity;
Pelvic Floor
- From:Journal of the Korean Radiological Society
2005;53(2):95-102
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To determine if pattern analysis of defecography can predict the responsiveness of biofeedback therapy in patients with chronic functional constipation. MATERIALS AND METHODS: Over a two-year period, 104 patients with chronic functional constipation underwent defecography and biofeedback therapy. Two blinded readers analyzed the defecographic findings and classified them into six types; I = normal defecation, II = hypertonic lower anal sphincter (poor anal opening due to a persistent contraction of the lower anal sphincter), III = dyskinetic puborectal sling (inadequate laxity of the puborectal sling), IV = spastic pelvic floor syndrome (persistent contraction of both the puborectal sling and the lower anal sphincter), V = unclassified (including paradoxical contraction of the anal sphincter), VI = anatomical obstruction. In addition, the degree of rectal contraction during defecation was scored (grade 0 to 3). After biofeedback therapy, the differences in the defecography patterns or rectal contractions between the two groups, the responsive or non-responsive group, were analyzed. RESULTS: The defecograms revealed that the type IV of the spastic pelvic floor syndrome was most common (50 of 104 patients, 48%), followed by II (21/104, 20%), III (12/104, 11.5%), V (9/104, 9%) and VI (12/104, 11.5%). Biofeedback therapy showed a therapeutic response in 71 out of 104 patients (68%) but failed in 33 patients (32%). However, there were no significant differences in the defecographic pattern between the responsive and non-responsive groups (p=0.630). The defecograms revealed rectal contractions in 78 patients (75%) and moderate to vigorous contractions (more than grade 2) in 66 patients. Most of the biofeedback-responsive group showed rectal contractions (66 of 71 patients, 93%, p<0.001). CONCLUSION: In patients with chronic functional constipation, there was no significant difference in the morphological patterns of the defecogram between the responsive and non-responsive biofeedback groups. However, the presence of rectal contractions during defecation was strongly associated with the therapeutic response after biofeedback therapy.
