Dear John,
You'll first have to prove what comes first. After all, raising the
intra-abdominal pressure can be pretty difficult if one has LBP, especially
the acute type, and the radiating type if non-acute.
So, the cause-consequence chain could just as well be:
LBP --> problems with raising the intra-abdominal pressure --> obstipation
or
LBP --> problems with raising the intra-abdominal pressure --> delayed
defecation --> further absorption of fluids from the stools --> obstipation
R.,
Frank Conijn, PT
Editor of Physical Therapist Update
Amsterdam
The Netherlands
----- Original Message -----
From: "John D. Perry, PhD" <[log in to unmask]>
To: <[log in to unmask]>
Sent: woensdag 9 mei 2001 22:46
Subject: Re: Alive and kicking? Here's a question
Henry writes:
> Ever since I have been working as a Physiotherapist, I have seen a
> consistent pattern of low back pain and constipation. I was
> wondering apart
> from drugs, what are people's opinion of the causes?? Are there
> any studies on this topic??
Since the mid 1980s, Gastroenterologists and colorectal
surgeons have generally been persuaded by research that
about half of all cases of constipation are "functional"
constipation; that is, caused by the inability to relax the anal
sphincter and pelvic floor when trying to empty the bowels.
The condition is variously known as "anismus" or "paradoxical
contractions" and other names. It is so widely recognized now
that a famous surgeon (Kjipers) once said that he would never
operate on a patient until functional constipation had been
ruled out by his biofeedback associate.
There are several articles on this topic on my website,
http://www.incontinet.com. Put "constipation" in the
Google box and "search this site" for a list.
Several years ago I started writing that most "Low
Back Pain" was really "Crotch Pain"; it's just easier
for the patient to ascribe the pain to the muscle's
attachment, rather than body. This observation was
based on measurement of anal sphincter EMG with
inserted sensors.
A few years ago I developed an "Anismus Index" for
the PerryMeter Pelvic Muscle Rehabilitation software.
It consists of (1) a measure of the muscle at rest, (2) a
measure during strong contraction, and (3) a measure
during attempted defecation or "push out".
The "push out" score SHOULD be like the resting
score; the extent to which it is actually more like the
"contract" score is called the "anismus index".
(i.e., the index is #3 over (#2 minus #1) So a resting
of 2 and contract of 20 with a push out of 9 would
yield an anismus score of 50% (9/(20-2).
So, IMHO, your observation of a relationship between "low back
pain" and "constipation" is entirely on the mark, Henry!
John Perry
John D. Perry, PhD, MDiv, BCIA-C, Dip.ABS
1192 Lakeville Circle * Petaluma, CA 94954 USA
Phone: 707-789-9135 * FAX: 707-789-9137
Current Email: [log in to unmask]
Email Forwarder: [log in to unmask]
Website: http://www.InContiNet.com
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