Services - Evaluation of Constipation, Lower Back Pain, & Sexual Dysfunction

Patients with chronic constipation are on the average younger in age than their incontinent counterparts, but female predominance persists. A history of constipation may date back into childhood in some, or a few months only in other patients. The mechanism by which functional outlet obstruction occurs is still unknown, and it is questionable whether all patients represent one clinical entity only. At least one study claims to have identified different types of 'anismus', and another has suggested at least one cause of anismus to be sexual abuse in childhood or adulthood.

In a more recently published study, a group which received verbal feedback by an instructor was compared with a group receiving feedback by visual display of pelvic floor EMG during straining. It was shown that the response rate was similar in both groups and resulted in symptom improvement of approximately 50%. The authors conclude that 'training in abdominal muscle contraction with pelvic floor relaxation is equally effective with or without a measuring device'; but admit that constant encouragement and praise by an instructor is necessary, as is a 'good rapport between patient and instructor'.