# NEW DIAGNOSIS FROM a COLON EXPERT:NON-RELAXING PUBORECTALIS MUSCLE-Biofeedback?



## SpAsMaN* (May 11, 2002)

Alrigth,what's the deal?I just had a defecography and a diagnosis out of it :NON-RELAXING PUBORECTALIS MUSCLEFrom what the doctor think,it should be the cause of my incomplete evacuation.







Should i be naive and beleive that?Apparently,i could learn how to relax this puborectalis muscle.


----------



## Kathleen M. (Nov 16, 1999)

If the muscles down there do not relax when they should it can be difficult to defecate properly and fully.Some people get the wiring messed up and when the signal goes down there to relax and let loose they actually tighten up.They can do biofeedback training to teach you how to relax it when you tell it to relax.K.


----------



## eric (Jul 8, 1999)

> quote:be naive and beleive that


Spasman, why do you have to be naive to beleive that diagnoses?Non-Relaxing Puborectalis Muscle Can Cause Constipation http://www.constipated.com/Chapters/7_nonr...ing_muscle.html


----------



## SpAsMaN* (May 11, 2002)

> quote:Spasman, why do you have to be naive to beleive that diagnoses?


When it comes to IBS diagnosis,Spasman always has a plan B.







Alrigth,where are these IBSers cured by Biofeedback?


----------



## eric (Jul 8, 1999)

Spasman, what did the sitz marker test show?"NON-RELAXING PUBORECTALIS MUSCLE"Is an elimination disorder." Palsson et al (2004) have reviewed the evidence showing that biofeedback is efficacious for constipation, fecal incontinence, anal pain, and other functional anorectal disorders. They found that the average probability of successful treatment outcome for patients treated with biofeedback was 67% for functional fecal incontinence and 62% for constipation."http://www.aapb.org/i4a/pages/index.cfm?pageID=3361Biofeedback has not shown to be that great for IBS, but more for Functional disorders of the anus and rectum or anorectal disorders.Dr Palsson sent me this.Applied Psychophysiology and Biofeedback, Vol. 29, No. 3, September 2004 ( 2004)Biofeedback Treatment for Functional AnorectalDisorders: A Comprehensive Efficacy Reviewhttp://ibsgroup.org/eve/forums?a=tpc&s=500...03181#109103181


----------



## SpAsMaN* (May 11, 2002)

Thanks Eric.I definitly have something to read and understand.







Biofeedback for Nonrelaxing Puborectalis:http://www.medscape.com/viewarticle/499987


> quote: Biofeedback for Nonrelaxing PuborectalisPatients with constipation arising from a nonrelaxing puborectalis often benefit from biofeedback.[6] In this modality, a device (e.g., an anorectal manometer) is used to monitor pelvic floor activity; electrodes may also be used for electromyographic (EMG) biofeedback. Patients observe pressure changes (or EMG activity) during attempts to evacuate. Through trial and error, they are taught to modify their responses until appropriate relaxation is achieved, the aim being to retrain the pelvic floor to relax during defecation. Training may have to be reinforced at intervals. Accurate determination of the success rate of biofeedback is difficult because the published literature consists primarily of case series and because most of the trials that have been conducted have not included a placebo arm. It has been estimated that the success rate may be as high as 70%; however, this estimate is probably overoptimistic.[7]


----------



## SpAsMaN* (May 11, 2002)

http://www.medrang.co.kr/service/paper/det...497&distri=Hang


> quote:Jae Heon Jeong, M.D., Jeong Seok Choi, M.D., Yong Jun Seo, M.D., Jun Hyun Kim, M.D. Department of General Surgery, Choon-Hae Hospital, Busan, Korea PurposeTo evaluate therapeutic effect of biofeedback therapy according to methods of diagnosis in patients with norelaxing puborectalis syndrome. MethodsFrom September, 1, 1998 to February, 30, 1999, the patients who were diagnosed with norelaxing puborectalis syndrome on anal electromyography (EMG) and/or cinedefecography (CD) underwent biofeedback therapy. The patients were divided into 3 groups according to the diagnostic method; CD group - only diagnosed on cinedefecography, EMG group - only diagnosed on anal electromyography, CDâ¢EMG group - diagnosed on both tests. ResultsNineteen patients were diagnosed nonrelaxing puborectalis syndrome on CD and/or EMG. There were 14 females and 5 males with a mean age of 40.8â'18.4 years. The patients were classified into CD group; five pati ents (26.3%); EMG group, eight patients (42.1%); CDâ¢EMG group, six patients (31.6%). The patients had 5.4â'3.7 sessions of outpatient EMG-based biofeedback sessions. Subjective symptoms after biofeedback therapy improved in 4 (80.0%), 6 (75%), 5 (83%) patients in CD, EMG, CDâ¢EMG groups, respectively. There was a statistically significant increase in spontaneous bowel movements, and a reduction in assisted bowel movements after biofeedback therapy in patients in all three groups (pÂ£Â¼0.05). However, no significant difference was found among the three groups. ConclusionThis study demonstrated that biofeedback therapy had a high therapeutic effect regardless to the diagnostic method. Therefore, biofeedbck therapy can be performed if one test results in the diagnosis of norelaxing puborectalis syndrome in patients with constipation. JKSCP 2001;17:26-32 Ã&#8230;Â°Â¿Ã¶ÂµÃ¥: Nonrelaxing puborectalis syndrome, Biofeedback therapy, Cinedefecography, Electromyography, Ã„Â¡Â°Ã±ÃÃ·Ã€Ã¥Â±Ã™ Ã€ÃŒÂ¿ÃÂºÃŽÃ€Ã¼ÃÃµ, Â»Ã½ÃƒÂ¼ÂµÃ‡Â¸Ã"Ã€ÃŒÂ±Ã¢ Ã„Â¡Â·Ã¡, Â¹Ã¨ÂºÂ¯Â¿ÂµÃˆÂ­ÃÂ¶Â¿ÂµÂ¼Ãº, Â±Ã™Ã€Ã¼ÂµÂµ Â°Ã‹Â»Ã§


----------



## Kathleen M. (Nov 16, 1999)

Well IBSers don't have to have pelvic floor dysfunction, so most people wouldn't be eligible for that sort of treatment.Pelvic floor dysfunction is something I do think those with constipation issues especially of the push for a long time can't get it out types. Also anyone who has continual incontenance issues may need to be tested for the other problem, the pelvic floor is loose when it should not be loose.K.


----------



## Feisty (Aug 14, 2000)

Yes, Kathy, that is correct. I am one of those with pelvic floor dysfunction---the muscle control was gone. I needed major surgery to try and tighten some of the pelvic floor, but' unfortunately, the anal muscle is gone and I only have 1/2 inch left. My Doc, who is a very good colon/rectal specialist and surgeon told me that there are more females with the type of dysfunction I have, but that a lot of the males have it the other way, like Spasman posted. He said that biofeedback can help them to "retrain" the muscles to relax.Spasman----try not to be so pessimistic about this diagnosis. Be positive and feel fortunate that there just may be something out there to help you.


----------



## SpAsMaN* (May 11, 2002)

I'm not really


> quoteessimistic


.It's just that i have never heard people here who has been cured with it.Perhaps because Biofeedback treatment is rare and in fact,i will have to travel to get this treatment.


----------



## SpAsMaN* (May 11, 2002)

http://www.pudendalnerve.info/forums/pnfor...php/t-1318.htmlBotox eased chronic pelvic pain in pilot study: levator ani spasms - GynecologySherry BoschertLAS VEGAS -- Promising results from a pilot study may lead to a role for botulinum toxin in relieving certain kinds of chronic pelvic pain, Dr. Sherin Jarvis said at the annual meeting of the American Association of Gynecologic Laparoscopists.Twelve women with pelvic floor muscle spasms and at least a 2-year history of undergoing multiple treatments for chronic pelvic pain were treated with injections of botulinum toxin type A (Botox) in the levator ani muscles. Investigators administered bilateral injections totalling 40 units of Botox in one of three different dilutions into the puborectalis and pubococcygeus muscles of patients under conscious sedation.One patient withdrew from the 12-week study in the final week. Overall, visual analog scale scores for dyspareunia and dysmenorrhea improved significantly. Non-significant trends toward improvements in nonmenstrual pain and dyschesia also were seen, said Dr. Jarvis of the University of New South Wales, Sydney, Australia.At baseline, all patients had hypertonicity of the pelvic floor muscles, which was confirmed by manometry. "In theory, this is normal muscle that behaves abnormally," causing spasms and pain, she said. Repeat manometry 4 weeks after treatment showed a 50% decrease in resting pressure, which represents an increased ability to release the muscles. The treatment effect waned by week 12, but still showed a 30% decrease in resting pressure, compared with baseline measurements.Overall quality-of-life scores did not change significantly but showed trends toward improvement. Scores for sexual ac tivity, however, improved markedly, with significantly reduced sexual discomfort and increased frequency of sex.The dilution strength of the Botox did not affect the results.Allergan Inc., which markets Botox, provided the agent free of charge to the investigators for the study. Other than that, the researchers have no ties to the company, she said.The results of this pilot study prompt ed the investigators to launch an ongoing study using repeated injections of Botox at the same or higher doses for women with pelvic floor muscle spasms and chronic pelvic pain. Another ongoing study incorporates urodynamic testing before and after Botox injections in the pelvic floor muscles of patients with concomitant lower urinary tract symptoms.A placebo-controlled study is planned for this year.BY SHERRY BOSCHERT San Francisco Bureau


----------



## SpAsMaN* (May 11, 2002)

How a muscle cannot relax?


----------



## Kathleen M. (Nov 16, 1999)

It gets the wrong signal from the nervous system.The biofeedback tends to work at the level of the nervous system so you can tell the muscle to do the right things rather than it getting the wrong messages.K.


----------



## eric (Jul 8, 1999)

Spasman, this is in PDF format."New Evidence that biofeedback is the treatment of choice for many patients with constipation."http://www.med.unc.edu/wrkunits/2depts/med...2005_digest.pdf


----------



## SpAsMaN* (May 11, 2002)

Rigth.I want to become a biofeedback expert NOW and i'm gonna get a machine.







I can actually rent it 50$ per month.


----------



## SpAsMaN* (May 11, 2002)

Few post on biofeedbackelvic floor dysfunction?Read that and comment please:http://ibsgroup.org/eve/forums/a/tpc/f/733.../m/87310479/p/1Anyone had biofeedback?:http://ibsgroup.org/eve/forums/a/tpc/f/722.../m/13310274/p/1


----------



## SpAsMaN* (May 11, 2002)

OK,what is the deal?I have look my defecography video many time and it seems that my angle of straining is not good so i need to squat.That's fine it explain the diagnosis of N-relaxing puborectalis or whatever.I think something could have caused this need for straining overtime...I see a "stricture" in the rectum much more higher than the pelvic floor.I think it could be more relevant than my bad angle.The "stricture" or spasm seems to only open when pressure build up from stools.That become uncorfortable in the pubic area where the rectum and the sigmoid meet.Why the doctor only focus in my lower rectum when i feel backed up much higher?


----------



## SpAsMaN* (May 11, 2002)

Or perhaps there is a natural stricture between the sigmoid and the rectum?


----------



## SpAsMaN* (May 11, 2002)

On my TV,it kind of looks like this:From:http://radiology.rsnajnls.org/cgi/content/full/220/2/343/F4







And oh Eric there was no Sitz marker left after 5 days from what i have seen on my x-rays.


----------



## SpAsMaN* (May 11, 2002)

http://www.emedicine.com/med/topic415.htmColonic ObstructionLast Updated: June 14, 2004


> quote:Abdominal examinationPerform the examination in standard fashion, ie, inspection, auscultation, percussion, and palpation.*Large bowel obstruction may be characterized by diminished or, in later stages, absent bowel sounds.*





> quote: Lab Studies: *Studies are directed at evaluating the dehydration and electrolyte imbalance that may occur as a consequence of large bowel obstruction * and at ruling out ileus as a diagnosis.Routine serum chemistries and urine specific gravity should be evaluated.Suggestion of an abnormal anion gap also should prompt an arterial blood gas measurement and/or a serum lactate level measurement.A decreased hematocrit level, particularly with evidence of chronic iron-deficiency anemia, may suggest chronic lower gastrointestinal bleeding, particularly due to colon cancer.A stool guaiac test also should be performed, for similar reasons.Although bowel obstruction, or even constipation, may mildly elevate the WBC count, substantial leukocytosis should prompt reconsideration of the diagnosis. Ileus, secondary to an intra-abdominal or extra-abdominal infection or another process, is a possibility.Imaging Studies: Flat and upright abdominal roentgenography demonstrates dilation of the small and/or large bowel and air fluid levels. An upright chest x-ray generally is ordered simultaneously to determine whether free air is present, which would suggest perforation of a hollow viscus and ileus rather than organic obstruction. *Tracing colonic air around the colon, into the left gutter, and down into the rectum or demonstrating an abrupt cut-off in colonic air suggests the anatomic location of the obstruction. *


----------



## SpAsMaN* (May 11, 2002)

Flux,spasms exist.Strictures aren't one?


----------



## Kathleen M. (Nov 16, 1999)

Spasm implys something that goes back to normal relaxation. It can be normal, it just is not all the time.Usually stricture from what I understand is something that is tight because of scar tissue or some other anatomical issue that won't go back to being the normal state unless you do something to release it.







Checking google most of the stricture of various things all imply that something is making the tube be narrow, usually scarring or something.So it sounds like at least generally a spasm is a muscular problem that can go bact to normal. Strictures aren't generally muscular but scar tissue or disease or inflamation making the tube be narrow.K.


----------



## SpAsMaN* (May 11, 2002)

That's correct K about complete obstruction.









> quote:Causes: Causes of adult large bowel obstruction include the following:Neoplasm (benign or malignant)Stricture (diverticular or ischemic)Incarcerated herniaVolvulusIntussusception, usually with an identifiable anatomic abnormality in adults but not in childrenImpaction or obstipation


 However,there is partial obstruction







:


> quoteartial obstruction, in which the patient appears obstipated but continues to pass some gas or stools, is a less urgent condition.





> quote:Imaging Studies: - A dilated colon without air in the rectum is more consistent with obstruction. The presence of air in the rectum is consistent with obstipation, ileus, or partial obstruction.


----------



## Kathleen M. (Nov 16, 1999)

I still thought psuedo-obstruction is a different problem that what would be spasm. Else we would all psuedo-obstruct every time we try to move food along the GI tract.Besides using the arguement that something that happnes in a few individuals and is an abnormal situation to say that all IBSers who have normal anatomy have spasms is not particularly good logic.K.


----------



## SpAsMaN* (May 11, 2002)

We posted simultaneously.


----------



## SpAsMaN* (May 11, 2002)

I don't know but it seems that bowel enemas could even mimic partial obstruction/spasms:


> quote:Imaging Studies: This finding can be misleading, particularly if the patient has undergone rectal examinations or enemas.


[/IMG]


----------



## SpAsMaN* (May 11, 2002)

Perhaps spasms/partial obstruction is a result from mucosa sensitivity.Also,maybe i'm not constipated but _obstipated_.


----------



## SpAsMaN* (May 11, 2002)

My diagnosis is also called Anismus:http://www.ajronline.org/cgi/content/full/177/3/633


> quote: Diagnosis of anismus is difficult, and it has been suggested that the no single test is specific enough to confirm its diagnosis. In a study of 112 constipated patients with anismus, researchers found proctographic evidence of anismus in 42 (37%) of the patients and electromyographic evidence of anismus in 40 (36%), but the results of both tests yielded positive findings in only 28 patients (25%) [7]. This study suggests that proctography can achieve higher specificity if the vigorous functional criteria that we used for diagnosis are applied and structural findings are ignored. *Indeed, diagnosis of anismus remains controversial because it affects patients in various waysâ€"causing constipation, incontinence, or no symptoms at all [26, 27]â€"leading to suggestions that it may be an epiphenomenon rather than a primary cause of constipation
> 
> 
> 
> ...


EDITED:














PS,I JUST TALK TO A BIOFEEDBACH PHYSIOTHERAPIST AND ANISMUS IS NOT NON-RELAXING PUBORECTALIS MUSCLE.


----------



## SpAsMaN* (May 11, 2002)

Here a scientific explanation why people get incomplete evacuation with the defecography.Medical Findings:http://www.squatplatform.com/medical_1.html


----------



## SpAsMaN* (May 11, 2002)

My "spasm" in the higher part of the rectum seems to be the Rectosigmoid junction.Perhaps THAT is an area sensitive to spasm







:http://www.ncbi.nlm.nih.gov/entrez/query.f...3&dopt=AbstractRectosigmoid junction: anatomical, histological, and radiological studies with special reference to a sphincteric function.Shafik A, Doss S, Asaad S, Ali YA.Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Egypt.The existence of a sphincter at the rectosigmoid junction (RSJ) is controversial. Recent studies have demonstrated a high-pressure zone within the RSJ which responds to sigmoid colon or rectal contractions by relaxation or contraction, respectively. These findings suggest the presence of a "physiological" sphincter at the RSJ. The current study investigated the anatomical and histological structure and the radiological picture of the RSJ in view of the possible existence of an anatomical sphincter at the RSJ and elucidating its function. The RSJ was studied in 28 cadavers (18 adults and 10 fully mature neonates) by dissection. A histological study of the RSJ was performed in 5 cadavers. Radiological examination using double-contrast barium enema was carried out in 50 healthy volunteers (mean age 44.2+/-14.4 years; 32 men, 18 women). The mucous membrane of the RSJ was found in folds forming a "mucosal rosette" of a mean length of 2.8+/-0.9 cm in adult specimens and 0.7+/-0.2 cm in neonates. The distal end of the mucosal rosette was sharply delineated and in some specimens protruded into the rectal lumen as a small nipple, which was surrounded by a "rectal fornix" on either side. The histological examination of the RSJ showed mucosal foldings with deep crypts surrounded by lymphocytic aggregates and marginated by muscularis mucosa. The circular muscle coat showed gradually increasing thickness towards the rectum. Nerve cells in the submucosa were located at three levels: in the vicinity of the muscularis mucosa, in the middle of the submucosa, and in the proximity of the circular muscle. Radiologically the opening of the sigmoid colon into the RSJ presented as a ring or crescent. Radiological striations representing the mucosal rosette were demonstrated. The RSJ appeared as a narrow contractile segment. The anatomical, histological, and radiological findings thus indicate that the RSJ is a segment which can be identified by its interior rather than outer aspect. *The study suggests the presence of an anatomical sphincter at the RSJ which seems to regulate the passage of stools from the sigmoid colon to the rectum.*


----------



## Kathleen M. (Nov 16, 1999)

Just thinking a sphincter that is supposed to be closed isn't really the same as a part of the colon that should not be closed down spasming are not the same thing.Now a sphincter that is not regulating the flow of stuff properly (like it won't open when it should or is open when it shouldn't) could be an issue without there being any spasming involved.K.


----------



## SpAsMaN* (May 11, 2002)

K,


----------



## SpAsMaN* (May 11, 2002)

Interesting:http://www.pslgroup.com/dg/23368a.htm


----------



## SpAsMaN* (May 11, 2002)

As far as i know,i think i still have IBS.But as i said,i have been diagnose with non relaxing puborectalis with push with a defecography.I mostly have terminal constipation so it enhance the pubo theory.The thing who buggle my mind is that non relaxing puborectalis "with push" occurs apparently at the evacuation.From what i understand,the pubo sling strangle the bowel creating incomplete evacuation. Here a photo of the puborectalis at work: http://www.naturesplatform.com/health_bene....html&s=&c=&x=1


----------



## SpAsMaN* (May 11, 2002)

I have talk to a specialist.Apparently someone can have IBS AND non-relaxing puborectalis.It was the doctor in the last link.


----------



## dlqc (May 17, 2018)

how are you now spasman. Have you been cured by biofeedback?


----------



## SpAsMaN* (May 11, 2002)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780204/


----------

