Evaluation of Gastrointestinal Motility and its Disorders by Uday C. Ghoshal

Author:Uday C. Ghoshal
Language: eng
Format: epub
Publisher: Springer India, New Delhi

Step 1. Provide Education on Anorectal Anatomy and Defecation Physiology

An understanding of normal defecation physiology, including an occurrence of high-amplitude colonic-propagated contractions after meals and awakening, may help the patient learn the sense of defecation and take advantage of these contractions to promote bowel movement and avoid unnecessary straining. The patient should be advised to respond to the sensation of stool and go to the toilet after awakening. An early morning caloric meal or a wake-up meal is usually recommended for patients in our center to promote the sensation of bowel movement. A previous study in Asia suggested that skipping breakfast was associated with constipation in working women in Japan [28].

At this step, the therapist can also elucidate the correlation between toilet-sitting posture and appropriate anorectal anatomy for stool passage, as well as the correlation between intra-abdominal pressure control by abdominal breathing and the effective pushing force. Patient education about anorectal anatomy and normal physiology of defecation can be done after making the diagnosis of defecation disorder. The appropriate toilet-sitting posture, abdominal breathing exercise, and recognition of normal defecation physiology can be practiced at home prior to scheduling the patient for biofeedback treatment. This process should be repeated again at the first session of biofeedback treatment for understanding tracings on the monitor, which represent coordination of abdominal muscles as well as pelvic floor and anal sphincter.

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