Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation

Divisione di Riabilitazione Gastroenterologica, Universit√° di Verona, Azienda Ospedaliera di Verone, Centro Ospedaliero Clinicizzato, Valeggio sul Mincio, Verona, Italy.
Gastroenterology (Impact Factor: 13.93). 08/2005; 129(1):86-97. DOI: 10.1053/j.gastro.2005.05.015
Source: PubMed

ABSTRACT Biofeedback is reported to be as effective for slow transit constipation as for pelvic floor dyssynergia and no more effective than education. We aimed to test the hypothesis that biofeedback benefits only patients with pelvic floor dyssynergia, describe the physiologic mechanism of treatment, and identify predictors of success.
Fifty-two patients (49 women; average age, 35 years), all with delayed whole gut transit, included 34 with pelvic floor dyssynergia, 12 with slow transit only, and 6 who met only 1 of 2 criteria for pelvic floor dyssynergia. All received 5 weekly biofeedback sessions directed at increasing rectal pressure and relaxing pelvic floor muscles during straining plus practice defecating a balloon. Patients were retested by questionnaire; symptom diary; balloon defecation; transit study at 1, 6, 12, and 24 months; and anorectal manometry at 1 and 6 months.
At 6 months, greater improvements were seen in pelvic floor dyssynergia compared with slow transit only; 71% versus 8% reported satisfaction ( P = .001), and 76% versus 8% reported >/=3 bowel movements per week ( P < .001). Improvements were maintained at 24 months of follow-up. Biofeedback eliminated dyssynergia in 91% and enabled 85% to defecate the balloon. Satisfaction was correlated with improved ability to defecate the balloon (rho = .73; P < .001), reductions in dyssynergia (rho = .69; P < .001), and increased rectal pressure during straining (rho = .36; P < .01). Success was predicted by pelvic floor dyssynergia, milder constipation, and less frequent abdominal pain at baseline.
Biofeedback is an effective treatment for pelvic floor dyssynergia but not slow transit constipation.

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    • "Greater specificity through 'physiological diagnoses' enhances outcomes for the primary symptoms and secondary abdominal symptoms. For example , randomized, controlled studies of biofeedback retraining for rectal evacuation disorders have demonstrated relief of defecatory symptoms [Enck et al. 2009] and abdominal symptoms such as pain and bloating [Chiarioni et al. 2005]. "
    Therapeutic Advances in Gastroenterology 11/2012; 5(6):381-386. DOI:10.1177/1756283X12442223
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    • "Camilleri presents pelvic floor dyssenergia (PFD) as an alternative diagnosis in patients with constipation. We agree that a proportion of patients with chronic constipation suffer from PFD and can benefit from specific treatment, such as biofeedback [Chiarioni et al. 2005; Shim et al. 2011] "
    Therapeutic Advances in Gastroenterology 11/2012; 5(6):387-393. DOI:10.1177/1756283X12460420
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    • "However, the treatment is not universally available and, for many patients, laxatives are used if lifestyle modification has not improved symptoms (Figure 1). It has also become clear that the treatment is more effective in those with evacuatory dysfunction rather than slow transit [Rao et al. 2010; Chiarioni et al. 2005]. This is in contrast to earlier studies that suggested behavioural therapy, biofeedback, was equally effective in patients with slow and normal transit [Battaglia et al. 2004; Wang et al. 2003; Emmanuel and Kamm, 2001; Chiotakakou-Faliakou et al. 1998]. "
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    ABSTRACT: Constipated patients who are refractory to simple lifestyle interventions will usually resort to laxatives, whether prescribed or over the counter. Clinical trial evidence is scarce for older medications such as laxatives, especially with a condition as chronic and subjective as constipation. Newer polyethylene glycol-based laxatives have been investigated under rigorous clinical trial settings, but comparisons between different laxatives are not available. Newer prokinetic agents, targeting peristalsis, intestinal secretion and the colonic flora, have been developed for laxative refractory constipation. This review focuses on the evidence for each of these agents, and the relative indications for each of them.
    Therapeutic Advances in Gastroenterology 01/2011; 4(1):37-48. DOI:10.1177/1756283X10384173
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