Emprego do biofeedback no tratamento da contração paradoxal dos músculos pubo-retal e esfincter anal externo em crianças com constipação intestinal crônica

Abstract

Intestinal constipation is not really a disease but a symptom besides being associated to affections outside the colon. A series of other complaints and symptoms may be envolved and their individual perception also varies. In the last 20 years, its incidence, ethiopathogeny, as well as diagnosis and treatment have been the object of innumerable studies. Research has ainied at possible derangements in ano-rectal and colonic dysfunction with the purpose of detecting signs other than merely “constipation”; experiments have also been carried out to expiam a cause for the chronic intestinal constipation defined as idiopathic. Thus radiology, electromyography and ano-rectal manometry studies were employed. During the year of 1980 paradoxical contraction of the pubo-rectal muscles and the anal extemal sphincter (anismus) were noticed with those last two methods, in an average of 60,0% of children with chronic intestinal constipation with or without encopresis. Ever since biofeedback technique has been used in an attempt to normalize the defecation mechanism. The purpose of this study was to try biofeedback in the treatment of such children, irrespective of eventual encopresis, but showing anismus, or paradoxical contraction of the aforenientioned muscles. Our cases comprised 26 children aged between 4-15 years (average 8 years old); of these, 17 (65,4%) were male and 9 of them (43,6%) were female. The average duration of intestinal constipation and encopresis was of 5,1 years. An average of 3,2 sessions of biofeedback training were perfomied to obtain muscular relaxation with improvement of encopresis and cessation of laxative intake. Follow-up averaged 18 months. Among 26 children who underwent treatment, 5,0 (14,2%) were stopped treament; of the 21 remaining patients, 12 (46,2%) were conipletely healed with normalization of bowel movements, no more encopresis and/or need for laxatives, with improvement in 8,0 (30,8%), and failure in one (3,8%) child. Overall satisfactory results were observed in 77,0% of the cases, this being similar to those presented in the literature, as far as improved and healed children are concemed.