Abstract
Biofeedback therapy improves symptoms inpatients with constipation and obstructive defecation.Whether it also improves anorectal function is unclear.Our purpose was to investigate prospectively the effects of biofeedback therapy on subjective andobjective parameters of anorectal function in 25consecutive patients with obstructive defecation.Biofeedback therapy consisted of pelvic floor relaxationexercises (phase I) and neuromuscular conditioning ofrectal sensation and rectoanal coordination, with asolid state manometry system and simulated defecationmaneuvers (phase II). The number of sessions wascustomized for each patient. Clinical improvement wasassessed from the changes in anorectal manometry,balloon (50 cc) expulsion test, and the symptom andstool diaries. The number of therapy sessions varied[mean (range) = 6 (2-10)]. After therapy, whenstraining as if to defecate, the percentage analrelaxation, intrarectal pressure, and defecation indexincreased (P < 0.001). The balloon expulsion time,laxative consumption, and straining effort decreased (P< 0.001). Before therapy, 16/25 (64%) patients hadimpaired rectal sensation, and after therapy thisimproved (P < 0.001). After therapy, 15/25 (60%) patients reported 75% satisfaction with bowelhabit and 8/25 (32%) reported ≥50% satisfaction (P< 0.001); 15/16 (94%) patients discontinued digitaldisimpaction. Biofeedback therapy not only improves subjective but also objective parameters ofanorectal function in at least 76% of patients byrectifying the underlying pathophysiologicdisturbance(s). Sensory conditioning and customizing thenumber of sessions may offer additionalbenefits.
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REFERENCES
Surrenti E, Rath DM, Pemberton JH, Camilleri M: Audit of constipation in a tertiary referral gastroenterology practice. Am J Gastroenterol 90(9):1471–1475, 1995
Rao SSC, Patel RS: How useful are manometric tests of anorectal function in the management of defecation disorders. Am J Gastroenterol 92:469–475, 1997
Rao SSC, Happel J: Obstructive defecation: A failure of rectoanal coordination. Gastroenterology 106:A557, 1994
Preston DM, Lennard-Jones JE: Anismus in chronic constipation. Dig Dis Sci 30:413–418, 1985
Bleijenberg G, Kuijpers HC: Treatment of spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 30:101–111, 1987
Papachrysostomou M, Smith AN: Effects of biofeedback on obstructive defecation Reconditioning of the defecation reflex? Gut 35(2):242–245, 1994
Loening-Baucke V: Modulation of abnormal defecation dynamics by biofeedback treatment in chronically constipated children with encopresis. J Pediatr 116:214–222, 1990
Wexner SD, Cheape JD, Jorge JMN, Heymen S, Jagelman DG: Prospective assessment of biofeedback for the treatment of paradoxical anal sphincter contraction. Dis Colon Rectum 34:769–776, 1991
Fleshman JW, Dreznik Z, Cohen E, Fry RD, Kodner IJ: Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle. Dis Colon Rectum 35:145–150, 1992
Bleijenberg G, Kuiijpers HC: Biofeedback treatment of constipation: A comparison of two methods. Am J Gastroenterol 89:1021–1026, 1994
Koutsomanis D, Lennard-Jones JE, Roy AJ, Kamm MA: Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Gut 37:95–99, 1995
Whitehead WE, Chaussade S, Corazziari E, Kumar D: Report of an international workshop on management of constipation. Gastroenterol Int 4:97–113, 1991
Rao SSC, Read NW, Davison PA, Bannister JJ, Holdsworth CD: Anorectal sensitivity and responses to rectal distension in patients with ulcerative colitis. Gastroenterology 93:1270–1275, 1987
Rao SSC, Hatfield R, Soffer E, Conklin JF, Rao S: Anorectal manometry in healthy adult volunteers. Gastroenterology 110:A742, 1996
Evans RC, Kamm MA, Hinton JM, Lennard-Jones JE: The normal range and a simple diagram for recording whole gut transit time. Int J Colorectal Dis 7:15–17, 1992
Mahieu P, Pringot J, Bodart P: Defecography. Description of a new procedure and results in normal patients. Gastrointest Radiol 9:247–251, 1984
Wald A, Tunuguntla AK: Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. N Engl J Med 310(20):1282–1287, 1990
Miner PB, Donelly TC, Read NW: Investigation of the mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 35:1291–1298, 1990
Karlbom U, Pahlman L, Nilsson S, Graf W: Relationships between defecographic finding rectal emptying and colon transit time in constipated patients. Gut 36:907–912, 1995
Sasaki Y, Munkakata A: High viscous luminal content causes different manometric outcomes between methodologies. Gastroenterology 108(4):A683, 1995
Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME, Schoetz DJ, Roberts PL, Murray JJ, Veidenheimer MC: Biofeedback training is useful in fecal incontinence but disappointing in constipation. Dis Colon Rectum 37:1271–1276, 1994
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Rao, S.S., Welcher, K.D. & Pelsang, R.E. Effects of Biofeedback Therapy on Anorectal Function in Obstructive Defecation. Dig Dis Sci 42, 2197–2205 (1997). https://doi.org/10.1023/A:1018846113210
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DOI: https://doi.org/10.1023/A:1018846113210