Anorectal Coordination Maneuver for Constipation and Dysfunctional Voiding

The goal is to produce a coordinated movement that consists of increasing intraabdominal (intrarectal) pressure while simultaneously relaxing the pelvic muscles. During the initial sEMG evaluation of the Valsalva maneuver, patients are asked to bear down or strain as if attempting to void or evacuate, which may elicit an immediate pelvic muscle contraction and closure of the anorectal outlet. This correlates with symptoms of constipation including excessive straining and incomplete evacuation. The results of the sEMG activity observed on the screen display must first be explained and understood by the patient before awareness and change can occur. Change begins with educating the patient on diaphragmatic breathing, proper positioning, and habit training. Relaxation and quieting the muscle activity while observing the screen is reviewed. Initially patients are instructed to practice these behavioral strategies; however, some patients may continue to feel the need to " push" or strain to assist with expulsion. While observing the sEMG muscle activity on the screen, they are instructed to slowly inhale deeply while protruding the abdominal muscles to increase the intraabdominal pressure. They are then asked to exhale slowly through pursed lips. The degree of the abdominal and anal effort is titrated to achieve a coordinated relaxation of the PFMs. Patients are encouraged to reproduce this maneuver during defecation attempts.

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