Sacral magnetic stimulation in puborectalis paradoxical syndrome

Background and Purpose: Our earlier studies have demonstrated that sacral magnetic stimulation (IMS) in the canine model, in healthy volunteers and in constipated subjects effected rectal pressure rise, decline of the rectal neck (anal canal) pressure as well as rectal evacuation. Based on these results, we studied the effect of sacral MS on defecation in patients with puborectalis paradoxical syndrome (PPS). Methods: Eleven subjects (8 women, 3 men; age 36-53 years) with PPS were enrolled in the study. The magnetic coil was placed on the back with its center located between L4 and L5. Stimulation parameters were set at 70% of maximum intensity, 40 Hz frequency and 2-second burst length with 2 seconds off. During MS, the rectal neck and gastric (intra-abdominal) pressures were measured. The procedure was performed in the empty and in the full rectum using the balloon expulsion test in the latter. Results: MS of the empty and balloon-filled rectum effected rise of the rectal pressure (p<0.001), decline of the rectal neck pressure (p>0.001) and no significant change of the intragastric pressure (p>0.05). The balloon was expelled to the exterior in all the patients. Conclusions: Sacral MS succeeded in dispelling to the exterior the water-filled rectal balloon. The method is simple, easy, non-invasive, non-radiologic and can be performed on an outpatient basis for the treatment of PPS.

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Improvement in Outlet Obstructive Constipation Symptoms After Vaginal Stent Treatment for Rectocele

Surgical Innovation ◽

10.1177/1553350620975616 ◽

2020 ◽

pp. 155335062097561

Author(s):

Yitong Yin ◽

Zhijun Xia ◽

Meng Luan ◽

Meiying Qin

Keyword(s):

Side Effects ◽

Obstructed Defecation ◽

Safe Procedure ◽

Rectal Balloon ◽

Obstructed Defecation Syndrome ◽

Incomplete Evacuation ◽

Stent Treatment ◽

Balloon Expulsion ◽

Rectal Pressure

Objective. The objective is to determine the possible improvement in outlet obstructive constipation symptoms after vaginal stent treatment for rectocele. Methods. Female patients with rectocele (n = 156) accompanied with outlet obstructive constipation were selected in this study. Longo’s obstructed defecation syndrome (ODS) questionnaire, rectoanal pressures, and rectal balloon expulsion (BET) were evaluated at baseline, 1 month follow-up, and 6 months follow-up. Moreover, the side effects and the potential reasons for giving up treatment were also detected. Results. Vaginal stent significantly decreased the straining intensity, shortened the straining extensity time, decreased the use of laxatives, and alleviated the symptoms of incomplete evacuation ( P < .05). The vaginal stent also increased the rectal pressure and shortened the balloon expulsion time ( P < .05). Conclusions. As an effective, feasible, and safe procedure, the vaginal stent can be recommended as a treatment of choice for rectocele combined with outlet obstructive constipation.

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Correlation of Rectal Balloon Expulsion Test Between Seated and Supine Position

The American Journal of Gastroenterology ◽

10.14309/00000434-201210001-01720 ◽

2012 ◽

Vol 107 ◽

pp. S697-S698

Author(s):

Shiva Ratuapli ◽

Adil Bharucha ◽

Doris Harvey ◽

Alan Zinsmeister

Keyword(s):

Supine Position ◽

Rectal Balloon ◽

Balloon Expulsion ◽

Balloon Expulsion Test

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Comparison of rectal balloon expulsion test in seated and left lateral positions

Neurogastroenterology & Motility ◽

10.1111/nmo.12208 ◽

2013 ◽

Vol 25 (12) ◽

pp. e813-e820 ◽

Cited By ~ 39

Author(s):

S. Ratuapli ◽

A. E. Bharucha ◽

D. Harvey ◽

A. R. Zinsmeister

Keyword(s):

Rectal Balloon ◽

Balloon Expulsion ◽

Balloon Expulsion Test

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Clinical utility of balloon expulsion test for functional defecation disorders

Annals of Surgical Treatment and Research ◽

10.4174/astr.2016.90.2.89 ◽

2016 ◽

Vol 90 (2) ◽

pp. 89 ◽

Cited By ~ 4

Author(s):

Moo-Kyung Seong

Keyword(s):

Clinical Utility ◽

Balloon Expulsion ◽

Defecation Disorders ◽

Balloon Expulsion Test ◽

Functional Defecation Disorders

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Anorectal physiology in health: A randomized trial to determine the optimum catheter for the balloon expulsion test

Neurogastroenterology & Motility ◽

10.1111/nmo.13552 ◽

2019 ◽

Vol 31 (4) ◽

pp. e13552 ◽

Cited By ~ 8

Author(s):

Yoav Mazor ◽

Gillian Prott ◽

Mike Jones ◽

John Kellow ◽

Anastasia Ejova ◽

...

Keyword(s):

Randomized Trial ◽

Anorectal Physiology ◽

Balloon Expulsion ◽

Balloon Expulsion Test

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Ameliorating Effects of Transcutaneous Electrical Acustimulation at Neiguan (PC6) and Zusanli (ST36) Acupoints Combined with Adaptive Biofeedback Training on Functional Outlet Obstruction Constipation

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/8798974 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Jie Liu ◽

Hulin Chen ◽

Dewei Wu ◽

Ruiling Wei ◽

Chaolan Lv ◽

...

Keyword(s):

Frequency Band ◽

Outlet Obstruction ◽

Low Frequency ◽

Biofeedback Training ◽

Before And After ◽

Balloon Expulsion ◽

Group A ◽

Functional Outlet Obstruction ◽

Group B ◽

Balloon Expulsion Test

Background. Stimulant laxatives are still considered the most common treatment for functional outlet obstruction constipation (FOOC). However, the effectiveness of laxatives is unsatisfactory, and the long-term use of laxatives may cause certain adverse events. With this in mind, it is, however, paramount that novel complementary treatment(s) and/or other forms of alternative medicine are adequately investigated. Aims. The study aims to explore the effects and potential mechanism(s) of transcutaneous electrical acustimulation (TEA) combined with adaptive biofeedback training (ABT) on FOOC. Methods. A total of forty-five patients with FOOC were recruited and were randomly assigned to receive either Macrogol 4000 Powder (MAC, 10 g bid) (group A, n = 15) only, ABT + MAC + Sham-TEA (group B, n = 15), or TEA + ABT + MAC (group C, n = 15) in a six-week study. Individual patients' constipation-symptoms (PAC-SYM) and constipation-quality of life (PAC-QOL) were both assessed and scored. Serum acetylcholine (Ach) and nitric oxide (NO) were measured from drawn blood samples while individual patients' heart rate variability (HRV) was calculated at baseline and after each corresponding therapy. Anorectal manometry and balloon expulsion test were both performed before and after treatment. Results. Firstly, participants in group C had significantly lower scores of PAC-SYM, PAC-QOL, and a decreased anal defecating pressure (ADP) as compared to participants in group B (all p<0.050). These results, however, suggest the TEAs effect. Secondly, the low-frequency band (LF)/(LF + HF) ratio in groups B and C were decreased as compared to group A (p=0.037, p=0.010, respectively) regarding HRV. On the other hand, the high-frequency band (HF)/(LF + HF) ratio in groups B and C showed an opposite outcome. Finally, the serum Ach in groups B and C was significantly higher as compared to group A (p=0.023, p=0.012, respectively). Of significant importance, the serum NO in groups B and C were notably low as compared to group A (p=0.001, p<0.001, respectively). Conclusions. TEA, combined with ABT, effectively improves constipation symptoms as well as QOL in FOOC patients. It is, however, achieved by decreasing ADP, which mechanisms are mediated via the autonomic and enteric mechanisms.

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