Dyssynergic Defecation
Conditions
Keywords
Dyssynergic Defecation, Electromyographic Biofeedback, Connective Tissue Massage, Functional Constipation, Constipation-Related Quality of Life, Anxiety
Brief summary
The goal of this randomized controlled clinical trial is to evaluate the effects of connective tissue massage (CTM) added to electromyographic biofeedback (EMG-BF) in adults with dyssynergic defecation (DD). The study will assess bowel function, constipation severity, anal sphincter function, quality of life, and anxiety. The study will include adults aged 18 years and older who have functional constipation according to the Rome IV criteria and a physician-confirmed diagnosis of DD. Participants will be randomly assigned to two groups: Control group: Participants will receive patient education and EMG-BF. Treatment group: Participants will receive the same patient education and EMG-BF, with additional CTM. Both groups will receive 12 treatment sessions over 6 weeks, with two sessions per week. Patient education will cover pelvic floor muscle anatomy, defecation physiology, diaphragmatic breathing, correct defecation posture and straining, nutrition, fluid intake, and physical activity. Researchers will assess participants before and after treatment. Assessments will include a 7-day bowel diary, constipation severity, anal sphincter activity measured by surface electromyography, constipation-related quality of life, and anxiety. Researchers will also record participants' physical, demographic, and clinical characteristics.
Interventions
OTHERElectromyographic Biofeedback (EMG-BF)
Electromyographic biofeedback (EMG-BF) will be applied using a Neurotrack Myplus Pro 4 device and surface electrodes. Participants will be positioned in the left lateral position. Surface electrodes will be placed around the anus at the 3 and 9 o'clock positions and on the transversus abdominis muscle. A ground electrode will be placed on the arm. Participants will practice pelvic floor and anal sphincter contraction and relaxation, diaphragmatic breathing, and abdominal muscle contraction while maintaining pelvic floor and anal sphincter relaxation. The training will aim to improve coordination among the abdominal muscles, respiratory muscles, pelvic floor, and anal sphincter. Each session will last approximately 20-25 minutes. EMG-BF will be provided twice weekly for 6 weeks, for a total of 12 sessions.
Connective tissue massage (CTM) will be applied to the lumbosacral region, progressing toward the thoracic, scapular, interscapular, and cervico-occipital regions. Before treatment, connective tissue mobility and circulatory responses will be assessed by palpation. Participants will sit upright with their hips, knees, and ankles flexed at 90 degrees. Tissue mobilization will be performed using the palmar surface of the third finger, with the distal interphalangeal joint flexed at 45-60 degrees. Each stroke will be repeated three times. Sessions will last approximately 5-15 minutes, depending on the treated region. CTM will be provided twice weekly for 6 weeks, for a total of 12 sessions, in addition to EMG-BF and patient education.
Sponsors
Selcuk University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years and older. * Individuals with functional constipation according to the Rome IV criteria. * Individuals diagnosed with dyssynergic defecation by a physician.
Exclusion criteria
* Individuals with systemic, neurological, or metabolic diseases. * Individuals who are pregnant. * Individuals with abdominal hernias or coexisting colonic diseases. * Individuals with a history of colorectal, gastrointestinal, spinal, or pelvic surgery. * Individuals with open wounds or tumors in the areas where massage will be applied.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Anal Sphincter Function | Baseline and after 6 weeks of treatment | Anal sphincter function will be assessed using surface electromyography during rest, contraction, and straining. The anismus index will also be calculated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Constipation Severity | Baseline and after 6 weeks of treatment | Constipation severity will be assessed using the Constipation Severity Scale. Higher scores indicate greater constipation severity.The scale consists of 16 items divided into three subscales: Obstructive Defecation, Colonic Inertia, and Pain. The maximum scores for the Obstructive Defecation, Colonic Inertia, and Pain subscales are 28, 29, and 16, respectively. The total score ranges from 0 to 73, with higher scores indicating greater constipation severity. |
Countries
Turkey (Türkiye)
Outcome results
None listed