The efficacy of a multidisciplinary approach to the management of constipation: a case series

The aim of this study was to evaluate a rehabilitative programme including biofeedback training for the treatment of chronic constipation. A prospective series of patients with constipation, as defined by the Rome II diagnostic criteria, were assessed by a clinician, a dietitian and a physiotherapist. Anorectal physiology investigations and defecography were performed prior to and after the programme. The treatment involved consultation by the dietitian, postural re-education and pelvic floor re-education regarding the proper pattern of defecation. The subjects were followed up in alternate weeks for the first 3 months and then monthly for another 3 months. Twenty patients have been recruited into the programme since 2005. Ten subjects have completed the course of treatment and three have defaulted; the remaining seven were still undergoing treatment at the time of writing. On completion of the programme, there was a significant improvement in fibre intake (pre-treatment=12.919 1.06 g; post-treatment= 20.266 1.064 g; P=0.001), average straining effort (pre-treatment=6.36 0.391; post-treatment=3.72 0.391; P=0.001) and average straining time (pretreatment=17.61 2.172 min; post-treatment=6.00 2.172 min; P=0.004). The subjects reported a >50% improvement in their symptoms. A rehabilitative programme for constipation can significantly ameliorate the problem of constipation. The method of anorectal manometry was employed to assess the paradoxical response of the anorectum during attempted defecation.