Journal Article

Psycho-echo-biofeedback: a novel treatment for anismus—results of a prospective controlled study

Pescatori, M., Cioli, V. M., Del Popolo, F., Plevi, T.

2014

Overview

Background Anismus or non-relaxing puborectalis muscle (PRM), detectable with anal/vaginal ultrasound (US), is a cause of obstructed defecation (OD) and may be treated with biofeedback (BFB). Many patients with anismus are anxious and/or depressed. The aim of this prospective study was to evaluate the outcome of the novel procedure psycho-echo-BFB in patients with anismus and psychological disorders. Methods Patients presenting at our unit with anismus and psychological disorders between January 2009 and December 2013, and not responding to conventional conservative treatment, were enrolled in the study. All underwent four sessions of psycho-echo-BFB, carried out by two psychologists and a coloproctologist, consisting of guided imagery, relaxation techniques and anal/vaginal US-assisted BFB. A validated score for OD was used, and PRM relaxation on straining measured before and after the treatment. PRM relaxation was also measured in a control group of 7 patients with normal bowel habits. Results Ten patients (8 females, median age 47 years, range 26–72 years) underwent psycho-echo-BFB. The OD score, evaluated prior to and at a median of 25 months (range 1–52 months) after the treatment, improved in 7 out of 10 patients, from 13.5 ± 1.2 to 9.6 ± 2.2 (mean ± standard error of the mean (SEM)), p  = 0.06. At the end of the last session, PRM relaxed on straining in all cases, from 0 to 7.1 ± 1.1 mm, i.e., physiological values, not statistically different from those of controls (6.6 ± 1.5 mm). Two patients reported were cured, 3 improved and 5, all of whom had undergone prior anorectal surgery, unchanged. No side effects were reported. Conclusions Psycho-echo-BFB is safe and inexpensive and allows all patients with anismus to relax PRM on straining. Previous anorectal surgery may be a negative predictor.

• Publisher: Springer Milan,Springer Nature B.V
• Subject: Abdominal Surgery / Adult / Aged / Anal Canal - physiopathology / Anus Diseases - complications / Anus Diseases - psychology / Anus Diseases - therapy / Anxiety Disorders - complications / Anxiety Disorders - therapy / Biofeedback, Psychology - methods / Case-Control Studies / Colorectal Surgery / Combined Modality Therapy / Constipation - etiology / Defecation - physiology / Depressive Disorder - complications / Depressive Disorder - therapy / Female / Gastroenterology / Humans / Medicine / Medicine & Public Health / Middle Aged / Muscle Relaxation - physiology / Original Article / Pelvic Floor / Pelvic Floor Disorders - complications / Pelvic Floor Disorders - psychology / Pelvic Floor Disorders - therapy / Proctology / Prospective Studies / Surgery / Treatment Outcome