Biofeedback Benefits Only Patients With Outlet Dysfunction, Not Patients With Isolated Slow Transit Constipation

Divisione di Riabilitazione Gastroenterologica, Universitá di Verona, Azienda Ospedaliera di Verone, Centro Ospedaliero Clinicizzato, Valeggio sul Mincio, Verona, Italy.
Gastroenterology (Impact Factor: 16.72). 08/2005; 129(1):86-97. DOI: 10.1053/j.gastro.2005.05.015
Source: PubMed


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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    • "They showed that a subgroup of patients with constipation have problems when they want to relax their pelvic floor muscles during excretion and inversely contract these muscles. The other researchers supported their observations [23]. "
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    ABSTRACT: Purpose: Pelvic floor muscle dysfunction is a common cause of constipation. This dysfunction does not respond to current treatments of constipation. Thus, it is important to identify this type of dysfunction and the role of these muscles in constipation. The purpose of the present study was to review the previously published studies concerning the role of pelvic floor muscles dysfunction in constipation and related assessment methods. Methods: Articles were obtained by searching in several databases including, Elsevier, Science Direct, ProQuest, Google scholar, and PubMed. The keywords that were used were ‘constipation,’ ‘functional constipation,’ and ‘pelvic floor dysfunction.’ Inclusion criteria included articles that were published in English from 1980 to 2013. A total of 100 articles were obtained using the mentioned keywords that among them articles about constipation, its definition, types, methods of assessment, and diagnosis were reviewed. Of these articles, 12 articles were related to the assessment procedures and pelvic floor muscle function in constipation. Results: The overall outcome of the studies provided sufficient evidence indicating the role of pelvic floor muscle dysfunction in constipation. Conclusion: Therefore, attention to this cause is effective in recovery process of these patients. There isn’t agreement to better assessment method. It seems that manometry is a good way in the medical field and palpation as an acceptable procedure can be used in rehabilitation field.
    Full-text · Article · Feb 2015
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    • "Uncontrolled studies have reported improvements in 50% to 71% of subjects undergoing BFT,5,28-30 and a recent controlled trial showed that BFT resulted in greater improvements at 1 year than laxatives.31 We observed symptomatic improvements in 56% of patients in the RH group, 61% of patients in the non-RH group, and 59% overall. "
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    ABSTRACT: BACKGROUNDAIMS: The pathophysiologic mechanism of rectal hyposensitivity (RH) is not well documented, and the significance of RH in biofeedback therapy (BFT) has not been evaluated. Thus, we aimed to assess the effect of BFT in constipated patients according to the presence of RH. Five hundred and ninety constipated patients (238 males and 352 females) underwent anorectal physiologic assessments. Of these, anorectal manometry was performed before and after BFT in 244 patients (63 RH and 181 non-RH patients). The success rate of BFT was 56% in the RH and 61% in the non-RH group (p=0.604). The measurements of resting pressure, squeezing pressure, desire to defecate volume, urge to defecate volume, and maximum volume were decreased after BFT in the RH group (p<0.05), whereas only resting and squeezing pressures were decreased in the non-RH group (p<0.05). Among the RH group, individuals who responded to BFT showed decreased resting pressure, squeezing pressure, desire to defecate, urge to defecate, and maximum volume and increased balloon expulsion rate; among those who did not respond to BFT, only desire to defecate volume was improved. In constipated patients with RH, changes of anorectal manometric findings differed in comparison to patients without RH. The responses to BFT showed both anorectal muscle relaxation and restoration of rectal sensation.
    Full-text · Article · Mar 2013 · Gut and liver
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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]. "

    Full-text · Article · Nov 2012 · Therapeutic Advances in Gastroenterology
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