Biofeedback therapy for constipation in adults

Abstract

Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. Today, it is possible to diagnose this problem and treat this effectively with biofeedback therapy, history, prospective stool diaries, and anorectal physiological tests. Several randomized controlled trails have demonstrated that biofeedback therapy using neuromuscular training and visual and verbal feedback is not only efficacious but superior to other modalities such as laxative or sham training. Also the symptom improvement is due a change in the underlying pathophysiology. Development of user friendly approaches to biofeedback therapy and use of home biofeedback programs will significantly enhance the adoption of this treatment by gastroenterologists and colorectal surgeons in the future. Improved reimbursement for this proven and relatively inexpensive treatment will carry a significant impact on the problem.

Neurogenic and myogenic motor patterns of rabbit proximal, mid, and distal colon

“…These pressure "complexes" recorded by the anal pressure transducer (Fig. 2) resemble manometrically recorded motor patterns reported in vivo in the proximal colon of rabbits (16), pigs (23), and sheep (7), and they have been observed in the human colon (19,32). This type of motility has been temporally associated with movement of colonic content in animals (7,16,23) and healthy human subjects (12).…”

Diagnosis and Treatment of Dyssynergic Defecation

“…Training can be discontinued if the patient's difficult defecation symptoms have improved and the patient can consistently demonstrate, over 2 consecutive training sessions, a normal pattern of defecation with at least 50% of attempts. 77 The success of biofeedback therapy depends on both the patient's motivation and the skill of the biofeedback therapist.…”

“…77 The solid-state manometry probe with microtransducers and a balloon is ideally suited for biofeedback therapy. Here, the transducers that are located in the rectum and anal canal provide a visual display of pressure activity throughout the anorectum.…”

Alteraciones intestinales en pacientes con lesión medular

“…Los pacientes con lesión medular motora incompleta (ASIA C y D), presencia de contracción voluntaria del esfínter anal externo y preservación de algún grado de sensibilidad a la distensión del recto podrían beneficiarse de la aplicación de técni-cas de biofeedback (rehabilitación del suelo pélvico) con el objetivo de mejorar la sensación anorrectal, potenciar la contracción del esfínter anal externo, coordinar la respuesta contráctil del esfínter anal con la sensación a la distensión rectal y reeducar la maniobra defecatoria. Se ha demostrado que el biofeedback es eficaz en el tratamiento de la incontinencia fecal de diversas etiologías 31 así como en el estreñimiento obstructivo 32 . Es especialmente importante recordar su utilidad en pacientes con esclerosis múltiple con incontinencia fecal y/o estreñimiento 33 .…”