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Biofeedback therapy for chronic constipation in a patient with Prader-Willi syndrome.

Corral JE, Kataria R, Vickers D, Koutouby R, Moshiree B - Ann Gastroenterol (2015 Oct-Dec)

Bottom Line: Relaxation of the puborectalis muscle improved significantly after three biofeedback sessions.Patient was successfully tapered off laxatives and has been maintained on linaclotide only.Dyssynergic defecation may be a common finding in Prader-Willi syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine (Juan E. Corral, Rahul Kataria), University of Miami Miller School of Medicine, Miami, Florida, USA.

ABSTRACT
Constipation is a common feature of Prader-Willi syndrome. Research exploring the prevalence, cause and treatment options for constipation is limited and lacks objective measurements such as anorectal manometry. We report a case of a 16-year-old lady with Prader-Willi syndrome presenting with rectal pain and constipation for 2 years despite multiple medications and weekly enemas. She also noted passive fecal incontinence that required frequent manual disimpactions. Anorectal manometry revealed an abnormal relaxation of the puborectalis and external sphincter muscles on push maneuvers suggesting dyssynergic defecation and rectal hypersensitivity. Contraction and relaxation of her pelvic muscles were recorded with electromyography. Relaxation of the puborectalis muscle improved significantly after three biofeedback sessions. Patient was successfully tapered off laxatives and has been maintained on linaclotide only. Dyssynergic defecation may be a common finding in Prader-Willi syndrome. In selected cases we recommend anorectal manometry to identify neuromuscular dysfunction and subsequent biofeedback therapy depending on the degree of mental retardation to minimize overuse of laxatives.

No MeSH data available.


Related in: MedlinePlus

Electromyogram readings before and after biofeedback. Dyssynergic defecation seen initially (arrow heads) disappeared with biofeedback. Puborectalis pressure increased during Kegel maneuvers (different scales, 9 mmHg pre and 70 mmHg post biofeedback) and abdominal pressure increased in Valsalva (scale 17.5 mmHg)
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Figure 2: Electromyogram readings before and after biofeedback. Dyssynergic defecation seen initially (arrow heads) disappeared with biofeedback. Puborectalis pressure increased during Kegel maneuvers (different scales, 9 mmHg pre and 70 mmHg post biofeedback) and abdominal pressure increased in Valsalva (scale 17.5 mmHg)

Mentions: Patient was considered to have DD with rectal hypersensitivity and she was referred for biofeedback therapy. Contraction and relaxation (via Kegel and Valsalva maneuvers) of her pelvic muscles were measured and recorded with electromyography. Push pressure of the puborectalis muscle improved significantly (paradoxical pressure peaks disappeared) after only 3 sessions (Fig. 2). Rectal manometry was not repeated after biofeedback therapy. Patient was successfully tapered off many of her laxatives. At a three-month follow-up appointment, she was maintained on linaclotide once daily, only along with continued biofeedback sessions recommended on her last visit. Patient was advised to complete 8 sessions of biofeedback to achieve maximal response but she was lost to follow up.


Biofeedback therapy for chronic constipation in a patient with Prader-Willi syndrome.

Corral JE, Kataria R, Vickers D, Koutouby R, Moshiree B - Ann Gastroenterol (2015 Oct-Dec)

Electromyogram readings before and after biofeedback. Dyssynergic defecation seen initially (arrow heads) disappeared with biofeedback. Puborectalis pressure increased during Kegel maneuvers (different scales, 9 mmHg pre and 70 mmHg post biofeedback) and abdominal pressure increased in Valsalva (scale 17.5 mmHg)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585403&req=5

Figure 2: Electromyogram readings before and after biofeedback. Dyssynergic defecation seen initially (arrow heads) disappeared with biofeedback. Puborectalis pressure increased during Kegel maneuvers (different scales, 9 mmHg pre and 70 mmHg post biofeedback) and abdominal pressure increased in Valsalva (scale 17.5 mmHg)
Mentions: Patient was considered to have DD with rectal hypersensitivity and she was referred for biofeedback therapy. Contraction and relaxation (via Kegel and Valsalva maneuvers) of her pelvic muscles were measured and recorded with electromyography. Push pressure of the puborectalis muscle improved significantly (paradoxical pressure peaks disappeared) after only 3 sessions (Fig. 2). Rectal manometry was not repeated after biofeedback therapy. Patient was successfully tapered off many of her laxatives. At a three-month follow-up appointment, she was maintained on linaclotide once daily, only along with continued biofeedback sessions recommended on her last visit. Patient was advised to complete 8 sessions of biofeedback to achieve maximal response but she was lost to follow up.

Bottom Line: Relaxation of the puborectalis muscle improved significantly after three biofeedback sessions.Patient was successfully tapered off laxatives and has been maintained on linaclotide only.Dyssynergic defecation may be a common finding in Prader-Willi syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine (Juan E. Corral, Rahul Kataria), University of Miami Miller School of Medicine, Miami, Florida, USA.

ABSTRACT
Constipation is a common feature of Prader-Willi syndrome. Research exploring the prevalence, cause and treatment options for constipation is limited and lacks objective measurements such as anorectal manometry. We report a case of a 16-year-old lady with Prader-Willi syndrome presenting with rectal pain and constipation for 2 years despite multiple medications and weekly enemas. She also noted passive fecal incontinence that required frequent manual disimpactions. Anorectal manometry revealed an abnormal relaxation of the puborectalis and external sphincter muscles on push maneuvers suggesting dyssynergic defecation and rectal hypersensitivity. Contraction and relaxation of her pelvic muscles were recorded with electromyography. Relaxation of the puborectalis muscle improved significantly after three biofeedback sessions. Patient was successfully tapered off laxatives and has been maintained on linaclotide only. Dyssynergic defecation may be a common finding in Prader-Willi syndrome. In selected cases we recommend anorectal manometry to identify neuromuscular dysfunction and subsequent biofeedback therapy depending on the degree of mental retardation to minimize overuse of laxatives.

No MeSH data available.


Related in: MedlinePlus