Long-Term Efficacy of Biofeedback Therapy for Dyssynergic Defecation: Randomized Controlled Trial

Abstract

Objectives Although biofeedback therapy is effective in the short term management of dyssynergic defecation, its long term efficacy is unknown. Our aim was to compare the one year outcome of biofeedback (manometric- assisted pelvic relaxation, and simulated defecation training), with standard therapy (diet, exercise, laxatives) in patients who completed 3 months of either therapy. Methods Stool diaries, visual analog scales (VAS), colonic transit, anorectal manometry, and balloon expulsion time were assessed at baseline, and at one year after each treatment. All subjects were seen at 3 month intervals and received reinforcement. Primary outcome measure (ITT analysis) was a change in the number of complete spontaneous bowel movements (CSBM) per week. Secondary outcome measures included bowel symptoms, changes in dyssynergia and anorectal function. Results Of 44 eligible patients with dyssynergic defecation, 26 agreed to participate in the long term study. All 13 subjects who received biofeedback, and 7 of 13 who received standard therapy completed one year; 6 failed standard therapy. The number of CSBMs/week increased significantly (p<0.001) in the biofeedback but not in the standard group. Dyssynergia pattern normalized (p<0.001), balloon expulsion time improved (p=0.0009), defecation index increased (p<0.001) and colonic transit time normalized (p=0.01) only in the biofeedback group. Conclusions Biofeedback therapy provided sustained improvement of bowel symptoms and anorectal function in constipated subjects with dyssynergic defecation while standard therapy was largely ineffective.

Efficacy and Predictors for Biofeedback Therapeutic Outcome in Patients with Dyssynergic Defecation

“…The pathogenic mechanisms are different for the different subtypes of DD, and the response to BFT may vary greatly between subtypes. Recent controlled studies have shown that BFT is an effective treatment for pelvic floor dyssynergia [15,42,43]; BFT was found to be superior to laxatives, with improvement being maintained over a long-term follow-up. The superior efficacy of BFT was also demonstrated by Wang et al [44] in their study of 50 CC patients.…”

Chronic Constipation: An Evidence-Based Review

“…Its value has been shown both in uncontrolled trials 93 and in recent randomized, controlled trials (RCTs) 46,92,94 for improving both psychological and clinical outcome measures. There have been no reports of adverse effects for using biofeedback.…”

Balloon Expulsion Test Does Not Seem to Be Useful for Screening or Exclusion of Dyssynergic Defecation as a Single Test

“…Therefore, screening of dyssynergic defecation with accuracy and giving appropriate treatment are important. 3 To diagnose dyssynergic defecation, changes in pressure in the rectum and anal sphincter muscles during attempted defecation are measured by using anorectal manometry (ARM). ARM is essential for a diagnosis of dyssynergic defecation.…”