Usefulness of Psyllium in rehabilitation of obstructed defecation

BACKGROUND: Rehabilitation is the first therapeutic step of obstructed defecation, after failure of conservative therapy with high-fiber diet and laxatives. This study evaluates the usefulness of psyllium, a bulk-forming agent, when used during rehabilitation of obstructed defecation. METHODS: Between January 2008 and December 2010, 45 patients affected by obstructed defecation were included in the study. Two randomized groups were selected. Group 1 (21 women; age range 25-67 (mean, 51.8) years) continued to consume a high-fiber diet (approximately 30 g fiber per day) during rehabilitation. Group 2 (24 women; age range 46-71 (mean, 59.8) years) consumed only psyllium (3.6 g × 2/day; Psyllogel(®) Fibra, Nathura, Montecchio Emilia, Italy) during the rehabilitative cycle. After a preliminary clinical evaluation, including the obstructed defecation syndrome (ODS) score, patients underwent defecography and anorectal manometry as well as rehabilitative treatment according to the "multimodal rehabilitative program" for obstructive defecation. At the end of the program, patients were reassessed by clinical evaluation and anorectal manometry. Post-rehabilitative ODS scores were used for an arbitrary schedule of patients divided into three classes: Class I, good (score ≤ 4); Class II, fair (score > 4 to ≤ 8); Class III, poor (score > 8). RESULTS: The number of bowel movements per week did not increase significantly after rehabilitation. Both groups had a significantly better Bristol stool form scale score (Group 1: P < 0.034; Group 2: P < 0.02). The overall mean ODS score from Groups 1 and 2 showed significant improvement after treatment (P < 0.001). Twenty-eight patients (82.3%) were Class I (good results) without significant differences between groups. Nine women were symptom-free. Significant differences were found between pre-rehabilitative and post-rehabilitative manometric data from the straining test (P < 0.001) and duration of maximal voluntary contraction (Group 1: P < 0.004; Group 2: P < 0.02). A significant difference was found between the pre-rehabilitative and post-rehabilitative conscious rectal sensitivity threshold (CRST) in Group 2 women (P < 0.02). The Group 2 women who underwent volumetric rehabilitation (11 patients) had significantly lower post-rehabilitative CRST values than pre-rehabilitative values (P < 0.002); the length of volumetric rehabilitation was also significantly shorter in Group 2 patients (P < 0.04) than in Group 1 patients. CONCLUSIONS: After rehabilitation of obstructed defecation, some patients became symptom-free and many had an improved ODS score. Psyllium is helpful for volumetric rehabilitation: patients who consumed psyllium had lower post-rehabilitative CRST values than subjects were on high-fiber diet.