Effects of biofeedback on obstructive defecation--reconditioning of the defecation reflex?

Abstract

Twenty two patients with obstructive defecation were recruited for relaxation training by domiciliary self regulatory biofeedback. Each patient served as his or her own control for anorectal and proctographic assessments. Biofeedback training improved the obstructive symptoms of the patients and showed significant change in various parameters related to the obstructive defecation syndrome. As examined by isotope dynamic proctography: the defecation rate (% of evacuation/ defecation time) was significantly increased (p<0O05), the anorectal angles at rest and during attempted defecation were made more obtuse (p<005), and the pelvic floor movements were made more dynamic on voluntary contraction of the anal sphincter (p<003). The external anal sphincter electromyographic voltage recorded during defecation was significantly reduced (p<00005) as was the surface anal plug electromyographic electrode voltage (p<0O0001), which was associated with a greatly reduced anismus index (p<0O0001). The rectal sensation was improved (p<005), cocomitantly. Biofeedback thus improves the defecation act in patients suffering from inappropriate contraction of the pelvic floor and sphincter musculature. Furthermore, this study has shown that biofeedback objectively influences the defecation reflex leading to an improved quality of higher control of bowel function.

Functional Constipation With Impaired Rectal Sensation Improved by Electrical Stimulation Therapy: Report of a Case

“…Biofeedback therapy is widely used for the management of these constipated patients and helps correct the dysfunctional defecating act, particularly in cases associated with pelvic floor dyssynergia. [1][2][3][4] However, some constipated patients often complain of absent or diminished sense of wanting to defecate and cannot benefit from biofeedback therapy alone.…”

The impact of anismus on the clinical outcome of rectocele repair

“…Evacuation proctography (EP), electromyography (EMG) of the pelvic floor, and balloon expulsion test (BET) are most commonly used to diagnose anismus, though in general, EMG is regarded as "the gold standard" [5]. Since anismus is a functional disorder, therapy consists of biofeedback training of the pelvic floor [6,7].…”

Biofeedback Therapy for Defecation Disorders

“…They include: EMG biofeedback [42-45, 47, 50-53]: balloon defecation [42, 47-49, 52, 53]; abdominal or diaphragmatic training [47][48][49]; water-perfused manometry [51,[54][55][56]: solid-state manometry [49], and home training units [52,57] The EMG biofeedback system consists of surface EMG electrodes that are mounted on a probe [42, 43, 45. 47], This device is placed inside the anus.…”

“…If required, surface EMG electrodes can be incorporated on the probe to provide visual and auditory display of the EMG activity. By repeated distention of the latex balloon, it is also possible to condition the impaired rectal sensation which occurs in 40% of patients with obstructive defecation [46,49,52], The distended balloon can also be pulled through the anus, simulating the act of defecation. The solid-state system appears to be comprehen sive and incorporates features described in each of the aforementioned devices.…”