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SİRİNGOMYELİ VE ARNOLD-CHİARİ MALFORMASYONU OLAN BİR OLGUDA KABIZLIK TEDAVİSİNE İLİŞKİN BİR OLGU SUNUMU

Year 2025, Volume: 3 Issue: 2, 1 - 5, 24.09.2025
https://doi.org/10.5281/zenodo.17184914

Abstract

Öz
Amaç: Bu çalışmada, Arnold-Chiari malformasyonu ve siringomyeli tanısı olan bir olguda kronik konstipasyon tedavisinde osteopatik manipülatif tedavi (OMT) teknikleriyle vagus sinirinin uyarılmasının etkinliğini değerlendirmek amaçlanmıştır.
Yöntem: Siringomyeli ve Arnold-Chiari malformasyonu tanısı olan 34 yaşındaki kadın hasta, kabızlık şikâyetiyle fizyoterapi kliniğine başvurmuştur. Hasta, Roma III kriterleri ve Konstipasyon Ciddiyet Ölçeği (KCÖ) ile değerlendirilmiştir. Ardından, tek seanslık osteopatik vagal sinir uyarımı uygulanmıştır. Uygulama sonrası bir ay süresince hasta haftalık takiplerle izlenmiş ve tedavi sonunda aynı ölçüm araçlarıyla yeniden değerlendirilmiştir.
Sonuçlar: Tedavi öncesinde KCÖ toplam puanı 46 olarak belirlenirken, birinci ay sonunda bu değer 6’ya düşmüştür. Hasta, tedavi öncesinde ayda en fazla beş kez dışkılama yaptığını belirtirken, tedavi sonrası dönemde her gün dışkılama gerçekleştiğini ifade etmiştir. Dışkı kıvamında yumuşama ve dışkılama sırasında zorlukta belirgin azalma bildirilmiştir.
Tartışma: Osteopatik manipülatif tedavi yoluyla yapılan vagal sinir uyarımı, invaziv olmayan, kolay uygulanabilir ve düşük maliyetli bir yöntem olarak kabızlık tedavisinde etkili olabilir. Bu vaka, Arnold-Chiari malformasyonu ve siringomyeli birlikteliğinde ortaya çıkan konstipasyonun yönetiminde OMT’nin potansiyelini ortaya koymakta olup, daha geniş örneklem gruplarıyla yapılacak çalışmalara öncülük edebilir.

References

  • 1. Garcia-Careaga M, Cox KM, Blankenberg F, Cox KL. Gastrointestinal Dysfunction Associated With Syringomyelia and Hydromyelia. J Pediatr Gastroenterol Nutr. 2000;31(1):71-75.
  • 2. Giner J, Pérez López C, Hernández B, et al. Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation. Neurologia. 2019;34(5):318-325.
  • 3. Flint G. Syringomyelia: diagnosis and management. Pract Neurol. 2021;21(5):403-411.
  • 4. da Silva JA, Brito JC, da Nóbrega PV. Autonomic nervous system disorders in 230 cases of basilar impression and Arnold-Chiari deformity.
  • 5. Bharucha AE. Constipation. Best Pract Res Clin Gastroenterol. 2007;21(4):709-731.
  • 6. Kaya N, Turan N. Validity and reliability of the Constipation Severity Instrument. Turkiye Klinikleri J Med Sci. 2011;31(6):1491-1501.
  • 7. Espí-López GV, Ruescas-Nicolau MA, Nova-Redondo C, et al. Effect of soft tissue techniques on headache impact and quality of life in migraine sufferers: a pilot study. J Altern Complement Med. 2018;24(11):1099-1107.
  • 8. Upledger JE. Craniosacral Therapy. In: Novey DW, ed. Complementary and Alternative Medicine. Mosby; 2000:381–392.
  • 9. Cabrera-Martos I, Valenza MC, Valenza-Demet G, et al. Effects of manual therapy on treatment duration in infants with plagiocephaly. Childs Nerv Syst. 2016;32:2211–2217.
  • 10. Zurowska A, Malak R, Kołcz-Trzęsicka A, et al. Compression of the fourth ventricle using a craniosacral osteopathic technique: A systematic review. Evid Based Complement Alternat Med. 2017;2017:2974962.
  • 11. Rnadottir TS, Sigurdardottir AK. Is craniosacral therapy effective for migraine? Complement Ther Clin Pract. 2013;19:11–14.
  • 12. Bengi G, Yalçın M, Akpınar H. Current approach to chronic constipation. Guncel Gastroenteroloji. 2014;18(2):181-197.
  • 13. Lindeman RD, Romeo LJ, Lian HC, et al. Should elderly persons be encouraged to drink more fluids? J Gerontol A Biol Sci Med Sci. 2000;55(7):361-365.
  • 14. Dinning PG, Hunt L, Patton V, et al. Sacral nerve stimulation in slow transit constipation: A randomized controlled study. Am J Gastroenterol. 2015;110(5):733-740.
  • 15. Ayas S, Leblebici B, Sozay S, et al. Effect of abdominal massage on bowel function in spinal cord injury. Am J Phys Med Rehabil. 2006;85:951-955.
  • 16. Micek ST, Ernst ME. Tolcapone: a novel approach to Parkinson's disease. Am J Health Syst Pharm. 1999;56:2195-2205.
  • 17. Lamas K, Graneheim UH, Jacobsson C. Experiences of abdominal massage for constipation. J Clin Nurs. 2012;21:757-765.
  • 18. Wells BG, DiPiro JT, Schwinghammer TL, DiPiro CV, eds. Constipation. Pharmacotherapy Quick Guide. McGraw-Hill; 2017.
  • 19. Tack J, Van Outryve M, Beyens G, et al. Prucalopride in treatment of severe chronic constipation in patients dissatisfied with laxatives. Gut. 2009;58:357-365.
  • 20. Liu S, et al. Transcutaneous electroacupuncture improves dyspeptic symptoms and HRV in functional dyspepsia. Neurogastroenterol Motil. 2008;20(11):1204–1211.
  • 21. Bonaz B, et al. Vagal tone: effects on sensitivity, motility, and inflammation. Neurogastroenterol Motil. 2016;28(4):455–462.
  • 22. Shi X, Hu Y, Zhang B, et al. Effects and mechanisms of auricular vagus nerve stimulation on abdominal pain and constipation. JCI Insight. 2021;6(14):e150052.
  • 23. Collebrusco L, Lombardini R. OMT and nutrition for irritable bowel syndrome. Explore. 2014;10(5):309-318.
  • 24. Brugman R, Fitzgerald K, Fryer G. Effect of osteopathic treatment on chronic constipation: a pilot study. Int J Osteopath Med. 2010;13(1):17-23.
  • 25. Hundscheid HW, Pepels MJ, Engels LG, et al. Osteopathy for IBS: results of a randomized pilot study. J Gastroenterol Hepatol. 2007;22(9):1394-1398.

A CASE REPORT ON THE TREATMENT OF CONSTIPATION IN A PATIENT WITH SYRINGOMYELIA AND ARNOLD-CHIARI MALFORMATION

Year 2025, Volume: 3 Issue: 2, 1 - 5, 24.09.2025
https://doi.org/10.5281/zenodo.17184914

Abstract

Abstract
Objective: This study aimed to evaluate the effectiveness of vagus nerve stimulation via osteopathic manipulative treatment (OMT) techniques in the management of chronic constipation in a patient diagnosed with Arnold-Chiari malformation and syringomyelia.
Methods: A 34-year-old female patient with a history of syringomyelia and Arnold-Chiari malformation presented with chronic constipation. She was assessed using the Rome III criteria and the Constipation Severity Instrument (CSI). A single session of osteopathic vagal stimulation was administered. The patient was monitored weekly for one month and re-evaluated at the end of the intervention using the same scales.
Results: The total CSI score decreased from 46 at baseline to 6 at the end of the first month. The patient reported defecating a maximum of five times per month prior to treatment, while achieving daily bowel movements after the intervention. A notable softening in stool consistency and reduction in straining were observed.
Discussion: Vagus nerve stimulation through OMT appears to be an effective, non-invasive, and cost-efficient method in the treatment of constipation. This case highlights the therapeutic potential of OMT in managing constipation associated with syringomyelia and Arnold-Chiari malformation, encouraging further studies with larger sample sizes.

References

  • 1. Garcia-Careaga M, Cox KM, Blankenberg F, Cox KL. Gastrointestinal Dysfunction Associated With Syringomyelia and Hydromyelia. J Pediatr Gastroenterol Nutr. 2000;31(1):71-75.
  • 2. Giner J, Pérez López C, Hernández B, et al. Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation. Neurologia. 2019;34(5):318-325.
  • 3. Flint G. Syringomyelia: diagnosis and management. Pract Neurol. 2021;21(5):403-411.
  • 4. da Silva JA, Brito JC, da Nóbrega PV. Autonomic nervous system disorders in 230 cases of basilar impression and Arnold-Chiari deformity.
  • 5. Bharucha AE. Constipation. Best Pract Res Clin Gastroenterol. 2007;21(4):709-731.
  • 6. Kaya N, Turan N. Validity and reliability of the Constipation Severity Instrument. Turkiye Klinikleri J Med Sci. 2011;31(6):1491-1501.
  • 7. Espí-López GV, Ruescas-Nicolau MA, Nova-Redondo C, et al. Effect of soft tissue techniques on headache impact and quality of life in migraine sufferers: a pilot study. J Altern Complement Med. 2018;24(11):1099-1107.
  • 8. Upledger JE. Craniosacral Therapy. In: Novey DW, ed. Complementary and Alternative Medicine. Mosby; 2000:381–392.
  • 9. Cabrera-Martos I, Valenza MC, Valenza-Demet G, et al. Effects of manual therapy on treatment duration in infants with plagiocephaly. Childs Nerv Syst. 2016;32:2211–2217.
  • 10. Zurowska A, Malak R, Kołcz-Trzęsicka A, et al. Compression of the fourth ventricle using a craniosacral osteopathic technique: A systematic review. Evid Based Complement Alternat Med. 2017;2017:2974962.
  • 11. Rnadottir TS, Sigurdardottir AK. Is craniosacral therapy effective for migraine? Complement Ther Clin Pract. 2013;19:11–14.
  • 12. Bengi G, Yalçın M, Akpınar H. Current approach to chronic constipation. Guncel Gastroenteroloji. 2014;18(2):181-197.
  • 13. Lindeman RD, Romeo LJ, Lian HC, et al. Should elderly persons be encouraged to drink more fluids? J Gerontol A Biol Sci Med Sci. 2000;55(7):361-365.
  • 14. Dinning PG, Hunt L, Patton V, et al. Sacral nerve stimulation in slow transit constipation: A randomized controlled study. Am J Gastroenterol. 2015;110(5):733-740.
  • 15. Ayas S, Leblebici B, Sozay S, et al. Effect of abdominal massage on bowel function in spinal cord injury. Am J Phys Med Rehabil. 2006;85:951-955.
  • 16. Micek ST, Ernst ME. Tolcapone: a novel approach to Parkinson's disease. Am J Health Syst Pharm. 1999;56:2195-2205.
  • 17. Lamas K, Graneheim UH, Jacobsson C. Experiences of abdominal massage for constipation. J Clin Nurs. 2012;21:757-765.
  • 18. Wells BG, DiPiro JT, Schwinghammer TL, DiPiro CV, eds. Constipation. Pharmacotherapy Quick Guide. McGraw-Hill; 2017.
  • 19. Tack J, Van Outryve M, Beyens G, et al. Prucalopride in treatment of severe chronic constipation in patients dissatisfied with laxatives. Gut. 2009;58:357-365.
  • 20. Liu S, et al. Transcutaneous electroacupuncture improves dyspeptic symptoms and HRV in functional dyspepsia. Neurogastroenterol Motil. 2008;20(11):1204–1211.
  • 21. Bonaz B, et al. Vagal tone: effects on sensitivity, motility, and inflammation. Neurogastroenterol Motil. 2016;28(4):455–462.
  • 22. Shi X, Hu Y, Zhang B, et al. Effects and mechanisms of auricular vagus nerve stimulation on abdominal pain and constipation. JCI Insight. 2021;6(14):e150052.
  • 23. Collebrusco L, Lombardini R. OMT and nutrition for irritable bowel syndrome. Explore. 2014;10(5):309-318.
  • 24. Brugman R, Fitzgerald K, Fryer G. Effect of osteopathic treatment on chronic constipation: a pilot study. Int J Osteopath Med. 2010;13(1):17-23.
  • 25. Hundscheid HW, Pepels MJ, Engels LG, et al. Osteopathy for IBS: results of a randomized pilot study. J Gastroenterol Hepatol. 2007;22(9):1394-1398.
There are 25 citations in total.

Details

Primary Language English
Subjects Physiotherapy, Rehabilitation
Journal Section Case Reports
Authors

Nermin Kart 0000-0002-9858-8927

Emre Baskan 0000-0001-7069-0658

Early Pub Date September 24, 2025
Publication Date September 24, 2025
Submission Date April 30, 2025
Acceptance Date May 27, 2025
Published in Issue Year 2025 Volume: 3 Issue: 2

Cite

Vancouver Kart N, Baskan E. A CASE REPORT ON THE TREATMENT OF CONSTIPATION IN A PATIENT WITH SYRINGOMYELIA AND ARNOLD-CHIARI MALFORMATION. Laodikya Rehabilitasyon Bilimleri. 2025;3(2):1-5.