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Satish S.c. Rao - One of the best experts on this subject based on the ideXlab platform.

  • long term efficacy of biofeedback therapy for dyssynergic defecation randomized controlled trial
    The American Journal of Gastroenterology, 2010
    Co-Authors: Satish S.c. Rao, Kice C Brown, Bridget Zimmerman, Jessica Valestin, Konrad Schulze
    Abstract:

    Long-Term Efficacy of Biofeedback Therapy for Dyssynergic Defecation: Randomized Controlled Trial

  • psychological profiles and quality of life differ between patients with Dyssynergia and those with slow transit constipation
    Journal of Psychosomatic Research, 2007
    Co-Authors: Satish S.c. Rao, Kara Seaton, Megan J Miller, Konrad Schulze, Kice C Brown, Jessica Paulson, Bridget Zimmerman
    Abstract:

    Abstract Background Pathophysiological characteristics differ between slow transit constipation (STC) and dyssynergic defecation, but whether psychological profiles and quality of life (QOL) are altered and whether they differ among these constipation subtypes are unknown. Methods We prospectively evaluated psychological profiles and QOL in 76 patients with Dyssynergia, 38 patients with STC, and 44 control subjects using the Revised 90-item Symptom Checklist and 36-item Short-Form Health Survey. In addition, we examined the correlations of psychological and QOL domains with constipation symptoms and pathophysiological subtypes. Results Symptom scores for hostility and paranoid ideation were higher ( P P P r c ≈.9) with the psychological subscores in patients with dyssynergic defecation and those with STC, although more QOL subscores among patients with dyssynergic defecation and more psychological subscores among patients with STC primarily contributed to the canonical correlations. A set of six commonly reported constipation symptoms showed significant correlations with QOL and psychological subscores, more so among patients with STC than among patients with dyssynergic defecation. Conclusions Patients with dyssynergic defecation had greater psychological distress and impaired health-related QOL as compared with patients with STC and control subjects. Both patient groups were also more affected as compared with the control group. There was a strong correlation between psychological dysfunction and impaired QOL, and both also correlated with constipation symptoms.

  • randomized controlled trial of biofeedback sham feedback and standard therapy for dyssynergic defecation
    Clinical Gastroenterology and Hepatology, 2007
    Co-Authors: Satish S.c. Rao, Kara Seaton, Megan J Miller, Kice Brown, Ingrid Nygaard, Phyllis J Stumbo, Bridgette Zimmerman, Konrad Schulze
    Abstract:

    Background & Aims: Constipation is a common disorder, and current treatments are generally unsatisfactory. Biofeedback might help patients with constipation and dyssynergic defecation, but its efficacy is unproven, and whether improvements are due to operant conditioning or personal attention is unknown. Methods: In a prospective randomized trial, we investigated the efficacy of biofeedback (manometric-assisted anal relaxation, muscle coordination, and simulated defecation training; biofeedback) with either sham feedback therapy (sham) or standard therapy (diet, exercise, laxatives; standard) in 77 subjects (69 women) with chronic constipation and dyssynergic defecation. At baseline and after treatment (3 months), physiologic changes were assessed by anorectal manometry, balloon expulsion, and colonic transit study and symptomatic changes and stool characteristics by visual analog scale and prospective stool diary. Primary outcome measures (intention-to-treat analysis) included presence of Dyssynergia, balloon expulsion time, number of complete spontaneous bowel movements, and global bowel satisfaction. Results: Subjects in the biofeedback group were more likely to correct Dyssynergia ( P P P = .02) than other groups. Colonic transit improved after biofeedback or standard ( P = .01) but not after sham. In the biofeedback group, the number of complete spontaneous bowel movements increased ( P P P = .03). Global bowel satisfaction was higher ( P = .04) in the biofeedback than sham group. Conclusions: Biofeedback improves constipation and physiologic characteristics of bowel function in patients with Dyssynergia. This effect is mediated by modifying physiologic behavior and colorectal function. Biofeedback is the preferred treatment for constipated patients with Dyssynergia.

  • influence of body position and stool characteristics on defecation in humans
    The American Journal of Gastroenterology, 2006
    Co-Authors: Satish S.c. Rao, Renae Kavlock, Sheila Rao
    Abstract:

    BACKGROUND: Whether defecation is influenced by body position or stool characteristics is unclear. AIM: We investigated effects of body position, presence of stool-like sensation, and stool form on defecation patterns and manometric profiles. METHODS: Rectal and anal pressures were assessed in 25 healthy volunteers during attempted defecation either in the lying or sitting positions and with balloon-filled or empty rectum. Subjects also expelled a water-filled (50 cc) balloon or silicone-stool (FECOM) either lying or sitting and rated their stooling sensation. RESULTS: When attempting to defecate in the lying position, a dyssynergic pattern was seen in 36% of subjects with empty rectum and 24% with distended rectum. When sitting, 20% showed Dyssynergia with empty rectum and 8% with distended rectum. More subjects (p < 0.05) showed Dyssynergia in lying position. When lying, 60% could not expel balloon and 44% FECOM. When sitting, fewer (p < 0.05) failed to expel balloon (16%) or FECOM (4%). FECOM expulsion time was quicker (p < 0.02). Stool-like sensation was more commonly (p < 0.005) evoked by FECOM than balloon. CONCLUSIONS: In the lying position, one-third showed Dyssynergia and one-half could not expel artificial stool. Whereas when sitting with distended rectum, most showed normal defecation pattern and ability to expel stool. Thus, body position, sensation of stooling and stool characteristics may each influence defecation. Defecation is best evaluated in the sitting position with artificial stool.

  • investigation of the utility of colorectal function tests and rome ii criteria in dyssynergic defecation anismus
    Neurogastroenterology and Motility, 2004
    Co-Authors: Satish S.c. Rao, Ranjit S Mudipalli, M Stessman, B Zimmerman
    Abstract:

    Although 30–50% of constipated patients exhibit Dyssynergia, an optimal method of diagnosis is unclear. Recently, consensus criteria have been proposed but their utility is unknown. To examine the diagnostic yield of colorectal tests, reproducibility of manometry and utility of Rome II criteria. A total of 100 patients with difficult defecation were prospectively evaluated with anorectal manometry, balloon expulsion, colonic transit and defecography. Fifty-three patients had repeat manometry. During attempted defecation, 30 showed normal and 70 one of three abnormal manometric patterns. Forty-six patients fulfilled Rome criteria and showed paradoxical anal contraction (type I) or impaired anal relaxation (type III) with adequate propulsion. However, 24 (34%) showed impaired propulsion (type II). Forty-five (64%) had slow transit, 42 (60%) impaired balloon expulsion and 26 (37%) abnormal defecography. Defecography provided no additional discriminant utility. Evidence of Dyssynergia was reproducible in 51 of 53 patients. Symptoms alone could not differentiate dyssynergic subtypes or patients. Dyssynergic patients exhibited three patterns that were reproducible: paradoxical contraction, impaired propulsion and impaired relaxation. Although useful, Rome II criteria may be insufficient to identify or subclassify dyssynergic defecation. Symptoms together with abnormal manometry, abnormal balloon expulsion or colonic marker retention are necessary to optimally identify patients with difficult defecation.

Ettore Mearini - One of the best experts on this subject based on the ideXlab platform.

  • biofeedback successfully cures detrusor sphincter Dyssynergia in pediatric patients
    The Journal of Urology, 2000
    Co-Authors: Massimo Porena, Elisabetta Costantini, W. Rociola, Ettore Mearini
    Abstract:

    Purpose: We assessed the efficacy of voiding and bladder biofeedback for achieving perineal synergy and curing symptoms in children with detrusor-sphincter DyssynergiaMaterials and Methods: A total of 16 boys and 27 girls 4 to 14 years old with detrusor-sphincter Dyssynergia diagnosed by uroflowmetry and electromyography underwent biweekly voiding biofeedback therapy consisting of perineal floor electromyography during uroflowmetry. The 6 patients with enuresis and an unstable bladder also underwent bladder biofeedback training during cystometry. Biofeedback continued until detrusor-sphincter Dyssynergia resolved. Followup consisted of electromyography and uroflowmetry 1 month after completing biofeedback training, and telephone interviews after 2 and 4 years.Results: Biofeedback resolved detrusor-sphincter Dyssynergia in all children, although the condition disappeared significantly sooner in girls (p <0.02). Secondary enuresis disappeared significantly earlier than primary enuresis (p <0.0001). The 2-ye...

  • BIOFEEDBACK SUCCESSFULLY CURES DETRUSOR-SPHINCTER Dyssynergia IN PEDIATRIC PATIENTS
    The Journal of urology, 2000
    Co-Authors: Massimo Porena, Elisabetta Costantini, W. Rociola, Ettore Mearini
    Abstract:

    Purpose: We assessed the efficacy of voiding and bladder biofeedback for achieving perineal synergy and curing symptoms in children with detrusor-sphincter DyssynergiaMaterials and Methods: A total of 16 boys and 27 girls 4 to 14 years old with detrusor-sphincter Dyssynergia diagnosed by uroflowmetry and electromyography underwent biweekly voiding biofeedback therapy consisting of perineal floor electromyography during uroflowmetry. The 6 patients with enuresis and an unstable bladder also underwent bladder biofeedback training during cystometry. Biofeedback continued until detrusor-sphincter Dyssynergia resolved. Followup consisted of electromyography and uroflowmetry 1 month after completing biofeedback training, and telephone interviews after 2 and 4 years.Results: Biofeedback resolved detrusor-sphincter Dyssynergia in all children, although the condition disappeared significantly sooner in girls (p

Gabrio Bassotti - One of the best experts on this subject based on the ideXlab platform.

  • biofeedback for pelvic floor dysfunction in constipation
    BMJ, 2004
    Co-Authors: Gabrio Bassotti, Fabio Chistolini, Antonio Morelli, Francis Sietchipingnzepa, G De Roberto, Giuseppe Chiarioni
    Abstract:

    Pelvic floor Dyssynergia is one of the commonest subtypes of constipation, and the conventional treatment (dietary fibre and laxatives) is often unsatisfactory. Recently biofeedback training has been introduced as an alternative treatment. The authors review the evidence for this approach and conclude that, although controlled studies are few and open to criticism, about two thirds of patients with pelvic floor Dyssynergia should benefit from biofeedback training Chronic constipation is a common self reported gastrointestinal problem that affects between 2% and 34% of adults in various populations studied. Among the subtypes of constipation, obstructed defecation seems particularly common, occurring in about 7% of the adult population.1 In most people with this conditionan inappropriate (paradoxical) contraction or a failed relaxation of the puborectal muscle and of the external anal sphincter often occurs during attempts to defecate (fig 1). This paradoxical contraction of the pelvic floor muscles during straining at defecation is considered a form of maladaptive learning and is generally defined (without specifying the underlying pathophysiological mechanism) as outlet dysfunction constipation or, more precisely, pelvic floor Dyssynergia.2 Fig 1 Anorectal manometric tracings of a normal subject (upper tracing) and a patient with pelvic floor Dyssynergia (lower tracing) during straining at defecation (arrows). Note that the normal subject relaxes the anal sphincter, whereas the patient displays a paradoxical contraction of the sphincter Cardinal symptoms of pelvic floor Dyssynergia are straining at stools and feelings of incomplete evacuation, and the diagnostic criteria, recently updated in the Rome II report, include those for functional constipation (see box)3 plus at least two out of three investigations (radiology, manometry, and electromyography) showing inappropriate contraction or failure to relax the pelvic floor muscles during attempts to defecate.2 #### Summary points Obstructed defecation is a common subtype of constipation that may not be responsive to treatment with laxatives and dietary …

  • long term study on the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor Dyssynergia and slow transit constipation
    Diseases of The Colon & Rectum, 2004
    Co-Authors: Edda Battaglia, Fabio Chistolini, Antonio Morelli, A Serra, Giuseppina Buonafede, L Dughera, G Emanuelli, Gabrio Bassotti
    Abstract:

    PURPOSE: Biofeedback training has been shown as an effective therapeutic measure in patients with pelvic floor Dyssynergia, at least in the short term. Long-term effects have received less attention. Moreover, its effects in patients with slow-transit constipation have been scarcely investigated. This study was designed to assess in an objective way the medium- and long-term effects of biofeedback and muscle training in patients with pelvic floor Dyssynergia and slow-transit constipation. METHODS: Twenty-four patients (14 with pelvic floor Dyssynergia and 10 with slow transit) meeting the Rome II criteria for constipation, and unresponsive to conventional treatments, entered the study. Clinical evaluation and anorectal manometry were performed basally and three months after a cycle of electromyographic biofeedback and muscle training; moreover, a clinical interview was obtained one year after biofeedback. Patients with slow-transit constipation also had colonic transit time reassessed at one year. RESULTS: Clinical variables (abdominal pain, straining, number of evacuations/week, use of laxatives) all significantly improved in both groups at three-month assessment; anorectal manometric variables remained unchanged, apart from a significant decrease of sensation threshold in the pelvic floor Dyssynergia group and of the maximum rectal tolerable volume in the slow-transit constipation group. At one-year control, 50 percent of patients with pelvic floor Dyssynergia still maintained a beneficial effect from biofeedback, whereas only 20 percent of those complaining of slow-transit constipation did so. Moreover, the latter displayed no improvement in colonic transit time. CONCLUSIONS: In our experience, patients with pelvic floor Dyssynergia are likely to have continued benefit from biofeedback training in the time course, whereas its effects on slow-transit constipation seems to be maximal in the short-term course.

  • One-Year Follow-Up Study on the Effects of Electrogalvanic Stimulation in Chronic Idiopathic Constipation With Pelvic Floor Dyssynergia
    Diseases of the colon and rectum, 2004
    Co-Authors: Giuseppe Chiarioni, Fabio Chistolini, Monica Menegotti, Lara Salandini, Italo Vantini, Antonio Morelli, Gabrio Bassotti
    Abstract:

    Constipation is a commonly reported symptom, and pelvic floor Dyssynergia is frequently documented in constipated patients. The standard therapeutic approach for pelvic floor Dyssynergia is biofeedback training, but long-term studies show that a significant percentage of patients remain symptomatic. Alternative or adjunctive therapeutic options are needed. The purpose of this study was to evaluate the long-term effects of electrogalvanic stimulation in patients with pelvic floor Dyssynergia and severe constipation, to see whether this treatment may be of some benefit. Thirty consecutive constipated patients with clinical and instrumental evidence of pelvic floor Dyssynergia entered the study and were treated with a standard high-frequency galvanic electrostimulation protocol. Clinical and instrumental (colon transit time, anorectal manometry, defecography, rectal balloon expulsion) assessment evaluations were performed basally and one year after the treatment. Overall, approximately 50 percent of patients showed significant improvement after electrogalvanic treatment, from both a clinical and an instrumental point of view, as shown by the objective measurements obtained through manometry, defecography, and the balloon expulsion test. The benefit was limited to normal transit constipation patients. Because of the relatively simple, painless and effective nature of electrogalvanic stimulation, we concluded that it may represent a useful adjunct to the therapeutic armamentarium for pelvic floor Dyssynergia in normal transit constipation.

Brigitte Schurch - One of the best experts on this subject based on the ideXlab platform.

  • Oral nitric oxide donors: a new pharmacological approach to detrusor-sphincter Dyssynergia in spinal cord injured patients?
    European urology, 2004
    Co-Authors: André Reitz, Peter A. Knapp, Michael Müntener, Brigitte Schurch
    Abstract:

    Abstract Purpose: Detrusor-sphincter Dyssynergia is a common cause of bladder outlet obstruction in spinal cord injured patients and leads to poor bladder emptying and high bladder pressures, which if left untreated might cause renal failure. In this study, we tested the recently published hypothesis that oral administration of a nitric oxide donor could be a new pharmacological approach to treat detrusor-sphincter Dyssynergia in humans with spinal cord injury. Methods: 12 male spinal cord injured patients presenting with neurogenic detrusor overactivity and detrusor-sphincter Dyssynergia were studied. 6 performed clean intermittent catheterisation and 6 used suprapubic tapping for bladder emptying. During cystometry the bladder was filled until the first overactive bladder contraction accompanied by detrusor-sphincter Dyssynergia occurred while bladder and external urethral sphincter pressures were continuously recorded. Then the bladder was emptied and the patients received 10mg of isosorbide dinitrate sublingually. Resting pressures were recorded and cystometry was repeated starting 15min after drug administration. Maximal and mean values for bladder and external urethral sphincter pressures were calculated in both fillings and statistically compared by analysis of variance for repeated measurements (level of significance p Results: Nitric oxide significantly reduced external urethral sphincter pressures at rest ( p p p Conclusions: Oral administration of nitric oxide donors significantly reduced bladder outlet obstruction due to detrusor-sphincter Dyssynergia suggesting a role for nitric oxide in inhibitory neurotransmission to the urethral sphincter. This new approach could offer a potential pharmacological option to treat detrusor-sphincter Dyssynergia in spinal cord injured patients.

  • Botulinum A toxin as a treatment of detrusor- sphincter Dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections
    Journal of neurology neurosurgery and psychiatry, 1997
    Co-Authors: Brigitte Schurch, Juerg Hodler, B Rodic
    Abstract:

    Objectives—To correlate clinical and urodynamic findings with MRI in patients with spinal cord injury and detrusorsphincter Dyssynergia who were consecutively treated with transperineal injections of botulinum-A toxin (BTX-A) under EMG control. Methods—Six patients with spinal cord injury and upper motor neuron bladder dysfunction associated with detrusorsphincter Dyssynergia were prospectively analysed. One hundred international units (IU) BTX-A (Botox® in 1 ml normal saline without preservative) diluted 1 to 1 with 1 ml gadopentetate were injected transperineally under EMG control. MRI was started immediately after needle withdrawal. Results—In all six patients gadopentetate was located in the external urethral sphincter on MRI. In no patient did traces of gadopentetate appear in the perineal musculature located in the vicinity of the external urethral sphincter. No patient developed resistance to BTX-A. All patients showed an (ongoing) improvement of their voiding function after BTX-A injections. Conclusions—Transperineal injections of BTX-A under EMG control are eYcient in the release or amelioration of lower urinary tract obstruction due to detrusor sphincter Dyssynergia in patients with spinal cord injury. Despite well described methods, EMG of the external urethral sphincter is diYcult and it is not possible to definitively exclude false recordings of the surrounding perineal musculature. By the use of MRI it was shown that both the EMG recordings and transperineal injection method are precise. (J Neurol Neurosurg Psychiatry 1997;63:474‐476)

  • botulinum a toxin as a treatment of detruosor sphincter Dyssynergia a prospective study in 24 spinal cord injury patients
    The Journal of Urology, 1996
    Co-Authors: Brigitte Schurch, D Hauri, B Rodic, Armin Curt, M Meyer, Alain B. Rossier
    Abstract:

    AbstractPurpose: The paralytic effect of botulinum-A toxin injections on the external urethral sphincter was investigated prospectively in patients with neurogenic voiding disorders.Materials and Methods: Transurethral versus transperineal botulinum-A toxin injections were performed in 24 spinal cord injury male patients with detrusor-sphincter Dyssynergia and the respective efficacy was compared.Results: In 21 of 24 patients detrusor-sphincter Dyssynergia was significantly improved with a concomitant decrease in post-void residual volumes in most cases. Botulinum-A toxin effects lasted 3 to 9 months, making reinjections necessary.Conclusions: Although costly, botulinum-A toxin injections, which aim at suppressing detrusor-sphincter Dyssynergia but not bladder neck Dyssynergia, appear to be a valid alternative for patients who do not desire surgery or are unable to perform self-catheterization.

  • Detrusor bladder neck Dyssynergia revisited.
    The Journal of Urology, 1994
    Co-Authors: Brigitte Schurch, K. Yasuda, Alain B. Rossier
    Abstract:

    AbstractTo our knowledge, direct measurement of active closure of the bladder neck during bladder contraction resulting in bladder neck Dyssynergia and outflow obstruction has not yet been demonstrated. A total of 34 spinal cord injury patients underwent urodynamic investigation with 2 micro-transducer catheters in the urethrovesical and anorectal regions, respectively. Proper localization of the transducers was done with an image intensifier. The respective role of the striated and smooth muscles on bladder neck activity was evaluated after pudendal nerve blocks and phentolamine injections. Of the patients 25 had active bladder neck Dyssynergia with concomitant detrusor-sphincter Dyssynergia. Pressures were higher in the bladder neck than in the bladder. Pudendal blocks abolished detrusor-sphincter but not bladder neck Dyssynergia, which was decreased by additional phentolamine but only in patients in whom bladder neck Dyssynergia was associated with autonomic hyperreflexia. Evidence is presented that ac...

Massimo Porena - One of the best experts on this subject based on the ideXlab platform.

  • biofeedback successfully cures detrusor sphincter Dyssynergia in pediatric patients
    The Journal of Urology, 2000
    Co-Authors: Massimo Porena, Elisabetta Costantini, W. Rociola, Ettore Mearini
    Abstract:

    Purpose: We assessed the efficacy of voiding and bladder biofeedback for achieving perineal synergy and curing symptoms in children with detrusor-sphincter DyssynergiaMaterials and Methods: A total of 16 boys and 27 girls 4 to 14 years old with detrusor-sphincter Dyssynergia diagnosed by uroflowmetry and electromyography underwent biweekly voiding biofeedback therapy consisting of perineal floor electromyography during uroflowmetry. The 6 patients with enuresis and an unstable bladder also underwent bladder biofeedback training during cystometry. Biofeedback continued until detrusor-sphincter Dyssynergia resolved. Followup consisted of electromyography and uroflowmetry 1 month after completing biofeedback training, and telephone interviews after 2 and 4 years.Results: Biofeedback resolved detrusor-sphincter Dyssynergia in all children, although the condition disappeared significantly sooner in girls (p <0.02). Secondary enuresis disappeared significantly earlier than primary enuresis (p <0.0001). The 2-ye...

  • BIOFEEDBACK SUCCESSFULLY CURES DETRUSOR-SPHINCTER Dyssynergia IN PEDIATRIC PATIENTS
    The Journal of urology, 2000
    Co-Authors: Massimo Porena, Elisabetta Costantini, W. Rociola, Ettore Mearini
    Abstract:

    Purpose: We assessed the efficacy of voiding and bladder biofeedback for achieving perineal synergy and curing symptoms in children with detrusor-sphincter DyssynergiaMaterials and Methods: A total of 16 boys and 27 girls 4 to 14 years old with detrusor-sphincter Dyssynergia diagnosed by uroflowmetry and electromyography underwent biweekly voiding biofeedback therapy consisting of perineal floor electromyography during uroflowmetry. The 6 patients with enuresis and an unstable bladder also underwent bladder biofeedback training during cystometry. Biofeedback continued until detrusor-sphincter Dyssynergia resolved. Followup consisted of electromyography and uroflowmetry 1 month after completing biofeedback training, and telephone interviews after 2 and 4 years.Results: Biofeedback resolved detrusor-sphincter Dyssynergia in all children, although the condition disappeared significantly sooner in girls (p