Deconstructing Obstructive Defecation Syndrome with Adaptive Biofeedback

Excerpt

The common syndromes of chronic constipation (CC) and obstructive defecation syndrome (ODS) have a significant impact on the quality-of-life of affected patients. In up to 40% of patients, CC is caused by the behavioral condition termed dyssynergic defecation (DD), which entails a paradoxical contraction, inadequate relaxation, or both of the puborectalis muscle, often associated with inadequate propulsive forces during defecation. Though the symptoms and physiological testing are the mainstay of diagnosis. [1, 2], the diagnosis of DD is however often difficult as more than half of healthy volunteers have manometric findings consistent with DD [3], possibly due to procedure-related factors such as positioning in the left lateral position and the embarrassing nature of the investigation [4]. According to several guidelines, DD can therefore only be diagnosed on the basis of at least two complementary tests (i.e., balloon expulsion tests, manometry, proctography, or defecography) [4, 5]. …