Efficacy of multidisciplinary approach in treatment of constipation: a pilot study

PYY Lau, B Fung, WCS Meng, R Leung, AWC Yip, SP So, QSY Lee, D Chan
Department of Surgery, Kwong Wah Hospital, Hong Kong

OBJECTIVE. To evaluate a multidisciplinary Hong Kong treatment programme for patients with constipation.

DESIGN. Pilot study.

SETTING. A joint collaboration among the departments of surgery, physiotherapy, and dietetics in a regional hospital in Hong Kong.

PATIENTS. Thirty-one constipated patients with normal colonic transit and pelvic floor dyssynergia.

INTERVENTION. Multidisciplinary treatment including dietary modification, bowel habit adjustment, and physiotherapy.

MAIN OUTCOME MEASURES. Anorectal manometry, fibre intake, subjective improvement, bowel frequency, Bristol score, and straining time and effort.

RESULTS. Significant improvement was found in mean fibre intake, straining time and effort, but not in anal manometric results. A total of 78% of patients demonstrated more than 50% improvement in subjective symptoms, whereas 70% of the patients enjoyed objective improvement in pelvic floor dyssynergia documented by electromyography and anal pressure during a push effort.

CONCLUSION. The multidisciplinary rehabilitative programme for constipated patients significantly improved symptoms. Electromyography and anal pressure during a push effort are useful tools for objective assessment of the treatment effect.

Hong Kong Med J 2006;12:415-8

Key words: Anal canal; Constipation; Digestive physiology; Rectum