A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults

Moore, D Winslow; Young, Christopher J.

doi:10.1007/s10151-020-02230-9

Cited by 14 publications

(10 citation statements)

References 30 publications

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“…Therefore, behavioral medical technologies such as BFT should be considered a valuable routine management rather than an alternative treatment. 45 The complexity of constipation and psychosomatic conditions in patients with FC overlapping UGS remains challenging for BFT. In our study we found that although BFT had a significant effect on FC overlapping UGS, the constipation symptoms of patients with FC overlapping UGS after BFT was still more severe compared with those with FC only.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis

Zhu,

Li,

Lyu

et al. 2024

J of Digest Diseases

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ObjectivesFunctional constipation (FC), a common functional gastrointestinal disorder, is usually overlapping with upper gastrointestinal symptoms (UGS). We aimed to explore the clinical characteristics of patients with FC overlapping UGS along with the related risk factors.MethodsThe differences in the severity of constipation symptoms, psychological state, quality of life (QoL), anorectal motility and perception function, autonomic function, and the effect of biofeedback therapy (BFT) among patients with FC in different groups were analyzed, along with the risk factors of overlapping UGS.ResultsCompared with patients with FC alone, those with FC overlapping UGS had higher scores in the Patient Assessment of Constipation Symptoms and Self‐Rating Anxiety Scale and lower scores in the Short Form‐36 health survey (P < 0.05). Patients with FC overlapping UGS also had lower rectal propulsion, more negative autonomic nervous function, and worse BFT efficacy (P < 0.05). Overlapping UGS, especially overlapping functional dyspepsia, considerably affected the severity of FC. Logistic regression model showed that age, body mass index (BMI), anxiety, exercise, and sleep quality were independent factors influencing overlapping UGS in patients with FC.ConclusionsOverlapping UGS reduces the physical and mental health and the QoL of patients with FC. It also increases the difficulty in the treatment of FC. Patient's age, BMI, anxiety, physical exercise, and sleep quality might be predictors for FC overlapping UGS.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis

Zhu,

Li,

Lyu

et al. 2024

J of Digest Diseases

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“…HRAM and balloon expulsion test (BET) are recommended as the first modalities to evaluate these patients. The principal objective of performing physiologic tests for constipated patients is to identify those with DD, as these patients would respond well to biofeedback therapy [ 13 , 28 ]. In short, the results of anorectal physiologic tests were directly associated with subsequent treatment choices for constipated patients.…”

Section: Discussionmentioning

confidence: 99%

Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis

Liu

Huang

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Background. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P < 0.001 ). Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. The outcomes demonstrated that the AUC was 0.85 (95% CI 0.82–0.88) with 77% summary sensitivity (95% CI 65–86) and 80% summary specificity (95% CI 71–86) to diagnose DD. Conclusions. DRE could be a valuable tool for screening DD. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. Meanwhile, our study highlights that DRE remains an important tool in clinical practice.

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“…2,3 A recent systematic review of biofeedback in the management of dyssynergic obstructed defaecation showed that up to 60% of patients having biofeedback therapy reported improvement in symptoms with some studies reporting up to 70% of patients had complete resolution of symptoms. 4 However, literature on the role of pelvic floor training or biofeedback in the setting of rectal prolapse and rectal intussusception is scarce. In a retrospective review of patients with rectal prolapse, Hamalaine and colleagues assessed the role of perioperative pelvic floor training as an adjunct to rectal prolapse surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Current literature suggests that pelvic floor training with or without biofeedback techniques results in improved outcomes in patient with faecal incontinence 2,3 . A recent systematic review of biofeedback in the management of dyssynergic obstructed defaecation showed that up to 60% of patients having biofeedback therapy reported improvement in symptoms with some studies reporting up to 70% of patients had complete resolution of symptoms 4 …”

Section: Introductionmentioning

confidence: 99%

Pelvic floor training improves faecal incontinence and obstructed defaecation despite the presence of rectal intussusception

Albayati

Bhai

Descallar

et al. 2022

ANZ Journal of Surgery

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Background Rectal intussusception is often observed in patients with faecal incontinence and obstructed defaecation. The aim of this study is to assess if pelvic floor training improves faecal incontinence and obstructed defaecation in patients with rectal intussusception. Methods Case notes of all patients referred to Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018 for the management of faecal incontinence and obstructed defaecation and rectal intussusception were retrospectively reviewed using a prospectively maintained database. St Mark's faecal incontinence and Cleveland clinic constipation scores were obtained from patients before and after they underwent pelvic floor training. Results One hundred and thirty‐one patients underwent pelvic floor training at Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018. Sixty‐one patients had rectal intussusception (22 low‐grade and 39 high‐grade). Median St Marks score improved following pelvic floor training from 8 to 1 (P < 0.001). Median Cleveland Clinic constipation score improved from 8 to 5 (P < 0.001). In patients with low grade rectal intussusception, pelvic floor training improved median St Mark's score from 3 to 0 (P = 0.003), whereas Cleveland Clinic constipation score improved from 9 to 7 (P < 0.001). In patients with high‐grade rectal intussusception, pelvic floor training improved median St Mark's score from 9 to 2 (P < 0.001), whereas median Cleveland Clinic constipation score improved from 8 to 4 (P < 0.001). Conclusion Pelvic floor training without biofeedback therapy improves faecal incontinence and obstructed defaecation. Improvement in symptoms is unrelated to rectal intussusception observed on proctography or at examination under anaesthesia in these patients.

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A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults

Cited by 14 publications

References 30 publications

Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis

Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis

Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis

Pelvic floor training improves faecal incontinence and obstructed defaecation despite the presence of rectal intussusception

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