Appl Psychophysiol Biofeedback (2017) 42:203–208
Relevance of the Clinical and Psychophysiological Variables
in the Dyssynergic Defecation: A Comparative Study in Elderly
Miguel A. Simón
· Ana M. Bueno
Published online: 21 June 2017
© Springer Science+Business Media, LLC 2017
Keywords Dyssynergic defecation · Chronic
constipation · Functional defecation disorders · Intra-anal
Chronic constipation is a very common gastrointestinal dis-
order, especially in the elderly, a population that has a high
prevalence (Rao and Go 2010; Sanchez and Bercik 2011).
This health problem has several adverse consequences, par-
ticularly a reduction in the quality of life and a very sig-
niﬁcant increase in the use of health care services, which
result in high costs, both direct and indirect (De Giorgio
et al. 2015).
Dyssynergic defecation is one of the more common
causes of chronic constipation. This functional defecation
disorder, characterized by diﬃculty expelling stool from
the anorectum due to paradoxical contraction or failure to
relax pelvic ﬂoor muscles, particularly the puborectalis
muscle and the external anal sphincter during straining to
defecate, aﬀects between 30–50% of patients with chronic
constipation (Rao 2008).
Several studies have established that behavioural treat-
ment with biofeedback is eﬀective and often can lead to
greater outcomes than other, more traditional therapeutic
approaches for the management of the dyssynergic def-
ecation in chronically constipated patients (Chiarioni et al.
2006; Heymen et al. 2005; Lee et al. 2015; Palsson et al.
2004; Pourmomeny et al. 2011; Sahin et al. 2015; Simón
et al. 2011). However, in elderly patients, data are lim-
ited to a single randomized controlled trial carried out by
our research group (Simón and Bueno 2009a). This work
showed signiﬁcant improvements both in clinical symp-
toms as well as anorectal physiology associated with
Abstract The relevance of several clinical and psycho-
physiological variables in the dyssynergic defecation in
elderly subjects was investigated in this study. To accom-
plish this, 30 elderly subjects (10 without anorectal dis-
orders, 10 with chronic constipation and 10 with dyssyn-
ergic defecation) were repeatedly assessed once per week
for 4 weeks, with the following measures being collected
at each session: EMG-activity (µV) of the external anal
sphincter (at rest, during squeezing, and during straining
to defecate), stool frequency, diﬃculty defecation level,
pain grade during defecation, and satisfaction level after
evacuation. A 3 (group) × 4 (sessions) mixed-measures
MANOVA revealed a signiﬁcant main eﬀect for group
(Wilks’s lambda = 0.006; F = 28.45; p < 0.01), but not for
sessions (Wilks’s lambda = 0.874; F = 0.94; p > 0.05) or for
the group x sessions interaction (Wilks’s lambda = 0.811;
F = 1.45; p > 0.05). One-way ANOVA and Scheﬀé’s post-
hoc tests were used to isolate the diﬀerences between the
groups with respect to the seven diﬀerent measures. These
analysis showed signiﬁcant diﬀerences between the groups
on all four clinical variables but only for one psychophysio-
logical variable, EMG-activity during straining to defecate.
Signiﬁcant diﬀerences were evidenced between all pairs
examined for the diﬃculty defecation level and pain grade.
The complete results of these analysis are presented and the
conclusions drawn from them are discussed.
* Miguel A. Simón
Department of Psychology, Clinical and Health Psychology
Research Unit, University of A Coruña, A Coruña, Spain