Successful physical therapy for constipation related to puborectalis dyssynergia improves symptom severity and quality of life

The Humanistic and Economic Burden of Chronic Idiopathic Constipation in the USA: A Systematic Literature Review

Background

Chronic idiopathic constipation (CIC) is a functional gastrointestinal disorder with an estimated prevalence of 16% in the USA; however, the humanistic and economic burden of CIC is poorly characterized.

Aim

This systematic literature review aimed to assess the humanistic and economic burden of CIC in adults in the USA.

Methods

Two systematic literature searches of English-language publications on the humanistic and economic burden of CIC in adults in the USA were conducted using electronic databases and other resources. Both searches included the terms "chronic idiopathic constipation" and "functional constipation". Specific terms used in the search on humanistic burden included "quality of life", "SF-36", "SF-12", and "PAC-QOL"; search terms for economic burden included "cost", "resource use", "absenteeism", and "productivity".

Results

Overall, 16 relevant articles were identified. Health-related quality of life (HRQoL) appeared to be reduced in patients with CIC compared with controls and the general US population. Abdominal (r=0.33-0.49), stool (r=0.23-0.33), and rectal symptoms (r=0.53) appeared to be associated with reduced HRQoL. Younger age and female sex were associated with reduced overall HRQoL and greater symptom severity. Direct outpatient costs were higher in patients with CIC than those without CIC (US$6284 vs US$5254). Patients with CIC and abdominal symptoms reported more days of disrupted productivity per month than those without abdominal symptoms (3.2 days vs 1.2 days). The overall prevalence of complementary and alternative medicine use by patients with CIC was similar to that in the general US population.

Conclusion

The reduced HRQoL and increased costs associated with CIC indicate unmet therapeutic need in this disorder. Further research is required to better understand the humanistic and economic burden of CIC in the USA.

Physiotherapist management of a patient with spastic perineal syndrome and subsequent constipation: a case report

Background and Purpose: The purpose of this case report is to describe the benefits of manual therapy techniques, including mobilization and stretching, in the management of a patient with chronic constipation. Case Description: A 17-year-old male with an 8-month history of constipation and complaint of incomplete evacuation after defecation was referred for therapy. The patient was diagnosed with a spastic perineal syndrome. Isolated puborectalis relaxation exercise was not successful in alleviating constipation. Physical examination showed tightness of left side piriformis, thoracic kyphosis, apparent limb shortening on the left side, and a right-on-right sacrum forward torsion. The patient was treated with stretching of left piriformis and mobilization of thoracic and lumbar vertebrae and sacroiliac joints along with puborectalis relaxation exercises. Outcomes: After 4 weeks of treatment, there was a reduction in Bowel Function Index (BFI) from 74.6 to 27.2. The patient also reported spending less time (<3 minutes) during defecation. The patient maintained his improvement at 7 months. Discussion: A detailed neuromuscular examination assisted in identifying the pathophysiology related to obstructive defecation for this patient. Controlled studies regarding the effectiveness of various physiotherapy interventions in the treatment of obstructive constipation are warranted.

The self-report fecal incontinence and constipation questionnaire in patients with pelvic-floor dysfunction seeking outpatient rehabilitation

BACKGROUND

Fecal incontinence and constipation affect men and women of all ages.

OBJECTIVE

The purpose of this study was to psychometrically analyze the Fecal Incontinence and Constipation Questionnaire (FICQ) in patients seeking outpatient rehabilitation services due to pelvic-floor dysfunction (PFD).

DESIGN

This was a retrospective analysis of cross-sectional data from 644 patients (mean age=52 years, SD=16, range=18-91) being treated for PFD in 64 outpatient rehabilitation clinics in 20 states (United States).

METHODS

We assessed the 20-item FICQ for unidimensionality and local independence, differential item functioning (DIF), item fit, item hierarchical structure, and test precision using an item response theory model.

RESULTS

Factor analyses supported the 2-factor subscales as originally defined; items related to severity of leakage or constipation. Removal of 2 leakage items improved unidimensionality and local independence of the leakage scale. Among the remaining items, 2 items were suggestive of adjustment for DIF by age group and by number of PFD comorbid conditions. Item difficulties were suitable for patients with PFD with no ceiling or floor effect. Mean item difficulty parameters for leakage and constipation subscales ranged from 38.8 to 62.3 and 28.1 to 63.3 (0-100 scale), respectively. Endorsed leakage items representing highest difficulty levels were related to delay defecation and confidence to control bowel leakage. Endorsed constipation items representing highest difficulty levels were related to the need to strain during a bowel movement and the frequency of bowel movements.

LIMITATIONS

A limitation of this study was the lack of medical diagnostic criteria to classify patients.

CONCLUSIONS

After removing 2 items and adjusting for DIF, the results supported sound psychometric properties of the FICQ items and its initial use for patients with PFD in outpatient rehabilitation services.

Changes in quality of life during biofeedback for people with puborectalis dyssynergia: generic and disease-specific measures

AIM

The aim of the study was to evaluate the changes in symptoms and quality of life in people with puborectalis dyssynergia after biofeedback by using Short Form-36 and Patient Assessment of Constipation Quality of Life Questionnaire.

BACKGROUND

Biofeedback is an effective treatment in clinical symptoms for puborectalis dyssynergia. However, little is known about the degree of the variation in the quality of life for these people after biofeedback.

METHOD

Thirty-six people with puborectalis dyssynergia were studied between June 2006 and March 2008. A bowel symptom record, a generic quality of life measure - the Short Form-36 and a disease-specific measure - the Patient Assessment of Constipation Quality of Life Questionnaire were recorded before and after biofeedback.

FINDINGS

Thirty-one people rated their satisfaction with behavioural treatment as 'major' or 'fair' and substantial symptom improvements occurred. Before treatment, seven of Short Form-36 subscales (except bodily pain) were significantly lower in people with puborectalis dyssynergia than those in healthy individuals. Following treatment, all subcategories except general health showed improvement surpassing pretreatment baseline values and equalling those for normal. The total Patient Assessment of Constipation Quality of Life Questionnaire score also dramatically improved as did all subscales. The nurses continually encouraged the participants, increased participants' motivation and got good outcomes.

CONCLUSION

Patient-centred functional status outcomes measured by general and disease-specific instruments give critical data, from which to inform patient management. The nurses should give psycho-social support and increase the participants' motivation during training.