NEUROMUSCULAR CONDITION THERAPY-DYSSYNERGIC DEFECATION

便秘影响了400万美国人，主要是妇女和老年人。其病理生理机制尚不完全清楚，治疗也不尽如人意。对泻药的依赖，以及无法完成大自然的召唤，许多人求助于绝望的治疗。大约50%的便秘患者表现出排便不协调或协同失调。非对照研究表明，生物反馈疗法可能会改善这些患者的症状。但是，这种改善是由于行为干预还是过度注意的结果尚不清楚。生物反馈疗法是一种劳动密集型、昂贵的疗法，而且只在少数几个中心提供。为了治疗社区中的许多患者，一个以家庭为基础的自我训练计划是必不可少的。我们的建议涉及三个目标：1)通过对排便功能障碍患者进行随机对照研究，确定生物反馈疗法的疗效。在通过结肠运输研究、肛门直肠测压和大便日记进行诊断评估后，90名患者将随机接受标准治疗，包括饮食、习惯训练和泻药，或者生物反馈治疗，包括神经肌肉调节或假反馈治疗。短期(3个月)和长期(12个月)评估肛门直肠生理排便指数、肛门松弛、FECOM排出时间和结肠通过时间，以及症状-肠道满意度评分、用力、泻药消耗评分以及大便形态和稠度。2)为了研究家庭训练与基于办公室的生物反馈疗法的疗效，以及它是否具有成本效益，100名患者将被随机分为两组，一组使用手持便携式设备和硅探头进行家庭训练，另一组接受为期3个月的生物反馈治疗。将评估肛门直肠的生理和症状，并比较每种治疗的精算成本。3)对于一种与心理纠缠在一起的疾病，没有关于生活质量或心理社会功能的信息。我们希望用SF-36和SCL-90-R对90名患者治疗前后的这些参数进行验证，并将其与两个对照组进行比较。这可能会为心理治疗等新的治疗方法提供动力。这项首次对照研究将确定安全和替代治疗排便困难的疗效和科学基础，提供有助于家庭自我训练的新信息，并评估治疗对肛门直肠生理、症状、生活质量和心理社会方面的影响。

Constipation affects 4 million Americans, predominantly women and the elderly. Its pathophysiology is incompletely understood and its treatment is unsatisfactory. Laxative-dependent, and unable to accomplish natures' call, many resort to desperate treatments. About 50 percent of patients with constipation exhibit uncoordinated or dyssynergic defecation. Uncontrolled studies suggest that biofeedback therapy may improve symptoms in these patients. But, whether the improvement is due to the behavioral intervention or a consequence of excess attention is not known. Biofeedback therapy is labor-intensive, expensive and only available in a few centers. In order to treat the many patients in the community, a home-based, self-training program is essential. Our proposal addresses three objectives; 1) to determine the efficacy of biofeedback therapy by performing a randomized controlled study in patients with dyssynergic defecation. After diagnostic evaluation with colon transit study, anorectal manometry and stool diaries, 90 patients will be randomized to receive standard treatment consisting of diet, habit-training and laxatives or biofeedback therapy consisting of neuromuscular conditioning or sham feedback therapy. Short-term (3 month) and long-term (12 month) assessments of anorectal physiology-defecation index, anal relaxation, fecom expulsion time and colon transit time and symptomatology-bowel satisfaction score, straining effort, laxative consumption score and stool form and consistency will be performed. 2) To investigate the efficacy of home-training versus office-based biofeedback therapy and if it is cost-effective, 100 patients will be randomized to receive either home-training using a hand-held portable device and a silicon probe or biofeedback therapy for 3 months. Anorectal physiology and symptoms will be assessed and actuarial costs of each treatment will be compared. 3) For a condition that is entwined with psyche there is no information on quality of life or psychosocial function. We wish to investigate these parameters with validated instruments, SF-36 and SCL-90-R in 90 patients, before and after treatment and compare this with two controlled groups. This may provide impetus for new treatments such as psychotherapy. This first controlled study will determine the efficacy and scientific basis for a safe and alternative therapy for difficult defecation, provide new information that could facilitate home self-training and assess the impact of treatment on anorectal physiology, symptoms, quality of life and psychosocial aspects.