Conservative rehabilitation of the elderly patients with impaired bowel emptying and pelvic organs prolaps
Aim: to assess the effectiveness of conservative rehabilitation with the use of biofeedback therapy in elderly patients with functional anorectal disorders and prolapse of the pelvic organs. Materials and methods. The study represents the results of a single-center prospective trial on effectiveness of conservative treatment of elderly (≥60 y. o.) patients with functional disorders of defecation and prolapse of the pelvic organs. To diagnose the presence of functional anorectal disorders we used Russian version of the specialized questionnaire “Score-system for the assessment of disorders of the evacuatory function of the colon”; high-resolution anorectal manometry (HRAM) with the standard software (Solar Gastro, MMS, The Netherlands) with 8-channel water-perfusion catheter (UniTip, Unisensor AG, USA); evacuation test with balloon and defecography, carried out according to the standard procedure. Biofeedback therapy was performed with the use of specialized hardware complexes Urostim (Canada) and WPM Solar (The Netherlands) in accordance to the standard technique. The effectiveness of treatment was evaluated after a course of biofeedback therapy using the same methods. Statistical analysis was carried out using a set of standard applications (Statistica, StatSoft, USA, MS Excel). Results. The study included 82 (89.1% of the follow-up group) women (mean±SD mean age: 64.7±5.5 years [min-max: 60-89 years]) and 10 (10.9% of the study participants) men (mean age 67.4±4.8 years [61-74 years]). According to HRAM, spasm of puborectal loop (type I manometric pattern) was diagnosed in 48/92 (52.2%) patients; type II pattern with increased pressure in the anal canal when straining relative to the pressure at rest with inadequate propulsions in 12/92 (13.0%); Type III manometric pattern with signs of incomplete relaxation with adequate propulsion - in 27/92 (29.4%) and type IV manometric pattern with inadequate propulsion - in 5 of 92 (5.4%). Positive dynamics and normalization of the state after the course of treatment were achieved in 38 (79.1%) patients with type I manometric pattern, in patients with initial type II manometric pattern - in 12 of 12 (100%), in the initial type III manometric pattern - in 20 of 27 (74.1%), and in type IV - in 5 of 5 (100.0%) patients. No adverse events were recorded during the study. No deterioration was detected in any of the cases. Conclusion: Implementation of the conservative rehabilitation with the use biofeedback therapy for the elderly patients who have functional defecation disorders leads to improvement of evacuation in 81.5% cases. Normalization of straining was achieved in 34.8% of cases, respectively.