Biofeedback provides long term benefit for patients with intractable, slow and normal transit constipation

Abstract

Background-Many patients with idiopathic constipation do not respond to conventional medical treatments. Recently biofeedback has been proposed as an alternative treatment but the long term results, and which patients benefit, are unknown. Treatment has usually been restricted to patients with normal colonic transit and impaired pelvic floor coordination on straining. Aims-To determine the eYcacy and long term outcome of biofeedback treatment in idiopathic constipation. Methods-One hundred consecutive contactable patients who had completed a course of biofeedback more than 12 months previously were identified. Pretreatment details of bowel function and symptoms, whole gut transit time, and anorectal physiological testing, which had been previously prospectively collected, were collated. Follow up consisted of structured interview. Sixty five per cent had slow transit and 59% had paradoxical pelvic floor contraction on straining. Results-Median follow up was 23 months (range 12-44). On long term follow up 55% felt that biofeedback had helped and 57% felt their constipation was improved. There was a significant reduction in need to strain, abdominal pain, bloating, and oral laxative use. Spontaneous bowel frequency was significantly improved by treatment. Patients with slow and normal transit, males and females, and those with and without paradoxical contraction of the anal sphincter on straining, benefited equally from treatment. Anorectal testing did not predict outcome. Conclusion-This study suggests that biofeedback is an eVective long term treatment for the majority of patients with idiopathic constipation unresponsive to traditional treatments. Pelvic floor abnormalities and transit time should not form selection criteria for treatment. (Gut 1998;42:517-521)

Are Constipated Children Different from Constipated Adults?

“…Approximately 85% of patients without a pathological finding, whose symptoms may have fit the criteria patients claiming to be improved after 6 weeks to 14 months' follow-up. However, there continues to be some for irritable bowel syndrome, improved or became symptom-free with the use of dietary fiber or laxatives such controversy among different authors about the benefit of biofeedback for both adults and children [53,54].…”

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

“…171 This eligibility is supported by the fact that outcome of biofeedback therapy varies widely, depending on whether the type of constipation can be represented as isolated defecatory disorder, isolated STC, or combined type. Most (about 70%) defecatory disorder was adequately relieved by biofeedback therapy [172][173][174][175][176][177][178][179] and this favorable effect lasted for 2 years or more, as observed in long-term follow-up data, 173,174,178,179 whereas only 8% of isolated STC cases were treated effectively. 180 Regardless of concomitant STC, combined type patients reached satisfactory outcomes.…”

Prospective Assessment of the Clinical Value of Anorectal Investigations

“…For example, when incontinence is found to relate to a degenerate [13]or disrupted internal sphincter alone [9], repair is not feasible, and either conservative treatment or more major reconstructive surgery will be required. The long-term outcome of biofeedback therapy for constipation has also been established [14]. …”