Spinal Stabilization Exercise Training in Women With Chronic Constipation

Scale Varma et al. it was developed by to determine individuals' defecation frequency, intensity and difficulty experienced during defecation. Kaya et al. Turkish validity and reliability were conducted by . The scale consists of 16 questions and three sub-areas. These areas are 1. Fecal Obstruction, 2. Large Intestinal Laziness and 3. Pain. The lowest total score that can be obtained from the scale is 0 and the highest is 73. A high score indicates that the symptoms are serious.

Spinal stability will be evaluated with the Sahrmann test and McGill trunk muscle endurance tests.

In the Sahrmann test, the Stabilizer Pressure Biofeedback Unit (Chattanooga, TN, USA) will be placed under the individuals' lumbar region and adjusted to 40mmHg. Individuals will be taught the abdominal bracing maneuver to ensure isolated contraction of the transversus abdominis muscle and spinal stability. Individuals will be asked to maintain abdominal bracing and perform different lower extremity movements at all levels of the test. The test consists of 5 levels and the difficulty level increases from level 1 to level 5. When the stabilizer value deviates more than 10 mmHg at each level, the test will be terminated, assuming that the person cannot complete that level.In McGill trunk muscle endurance tests, individuals will be subjected to trunk flexion, extension, right and left lateral flexion endurance tests.

Marquis et al. it was developed by (Marquis et al., 2005) in 2005, and its Turkish validity and reliability were tested by Dedeli et al. It was revealed by. The scale consists of 28 items and has 4 subdomains: "physical discomfort", "psychosocial discomfort", "worry/anxiety" and "satisfaction". The lowest score that can be obtained from the scale is 28 and the highest score is 140. Higher scores from the scale mean that the quality of life is more negatively affected.

Individuals will be asked to complete a bowel diary one week before starting treatment and for 7 days after the study is completed. In these diaries, they will be asked to mark each day they defecate, how long they spend in the toilet for each defecation, the feeling of incomplete defecation, the use of medication to defecate, changes in nutrition and fluid consumption, and pain during defecation . They will also be asked to record stool type according to the Bristol Stool Scale in their bowel diary. This scale was developed by Lewis and Heaton and human feces are classified into 7 groups. Since the shape of the stool changes depending on the time it stays in the colon, it is a rapid and reliable indicator of colonic transit time. Stool type will be determined according to the data obtained from the scale.

Individuals' perception of improvement in constipation complaints at the end of treatment will be questioned with the "Patient Global Impression of Improvement Scale" as follows. "How would you describe your current condition in terms of constipation compared to your condition at the beginning of treatment?" The available answers to this question are "Much better (1)", "Better (2)", "Somewhat better (3)", "No change (4)", "Somewhat worse (5)", "Worse (6)" and "Much worse (7)". Individuals will be asked to mark the answer that best describes their condition among the available answers.

After the treatment, the physical activity, nutrition (fiber and fluid intake) recommendations and compliance with the recommendations given regarding defecation position will be evaluated with the "Visual Analog Scale (VAS)". Individuals will be asked to mark the point that best describes them on a horizontal line with a real length of 10 cm. The distance of the marked point to the "0" point will be measured with a ruler and recorded in cm. On this scale, the "0" point will be defined as "I did not comply at all (%0)" and the "10" point will be defined as "I showed complete compliance (%100)".