Effects of Connective Tissue Massage Plus Biofeedback for Dyssynergic Defecation

The goal of this randomized controlled clinical trial is to evaluate the effects of connective tissue massage (CTM) added to electromyographic biofeedback (EMG-BF) in adults with dyssynergic defecation (DD). The study will assess bowel function, constipation severity, anal sphincter function, quality of life, and anxiety. The study will include adults aged 18 years and older who have functional constipation according to the Rome IV criteria and a physician-confirmed diagnosis of DD. Participants will be randomly assigned to two groups: Control group: Participants will receive patient education and EMG-BF. Treatment group: Participants will receive the same patient education and EMG-BF, with additional CTM. Both groups will receive 12 treatment sessions over 6 weeks, with two sessions per week. Patient education will cover pelvic floor muscle anatomy, defecation physiology, diaphragmatic breathing, correct defecation posture and straining, nutrition, fluid intake, and physical activity. Researchers will assess participants before and after treatment. Assessments will include a 7-day bowel diary, constipation severity, anal sphincter activity measured by surface electromyography, constipation-related quality of life, and anxiety. Researchers will also record participants\' physical, demographic, and clinical characteristics.