Sensory discrimination training in the treatment of a case of chronic constipation

A 31-year-old woman with a history of life-long constipation and laxative dependence was treated with discrimination training for rectal sensation. She had complained of absence of the urge to defecate, bloating with abdominal discomfort, and need for laxatives to relieve symptoms. Manometric examination with an anorectal balloon assembly revealed a normal threshold for sphincteric reflexes, but an abnormally elevated threshold for detection of rectal distention. Behavioral treatment consisted of a manometrically based sensory discrimination procedure designed to reduce the sensory threshold for rectal distention. Multiple training sessions with this procedure allowed recognition of progressively smaller rectal distention volumes. Accompanying these changes in rectal sensory threshold were concomitant increases in the frequency of bowel movements, decreases in the weekly use of laxatives, and decreases in subjective discomfort. Therapeutic effects were maintained at follow-up examination one year later. The results of this case study suggest that behavioral training to increase rectal sensation may be useful in treating constipation in patients who have abnormal rectal sensory thresholds. © 1987 Association for Advancement of Behavior Therapy. All rights reserved.

Duke Scholars

Author Richard Samuel Surwit Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...