Biofeedback Fights Constipation

OB/GYN News, Jan 15, 2001 by Sally Kubetin

Biofeedback is an effective long-term therapy for the most common cause of chronic constipation, Dr. Satish S.C. Rao reported at the annual meeting of the American College of Gastroenterology in New York.

Roughly 50% of all cases of chronic constipation are due to a failure of coordination between the pelvic floor muscles and the anal sphincter--a condition called dyssynergic defecation, or anismus.

A biofeedback training program corrected the dyssynergic defecation pattern in all 80 patients who completed it, and improvement was generally sustained at 6 weeks, 6 months, and 1 year of follow-up. Indeed, at 1 year, 90% of patients showed strong improvement in manometric measurements of anorectal coordination, rectal sensation, and balloon expulsion. Moreover, 75% of patients noted significantly decreased straining in self-maintained defecation diaries. Self-reported stool frequency climbed from 4.2 per week at baseline to 7.2 per week at 1 year. Overall, 75% of patients expressed satisfaction with their bowel function, said Dr. Rao of the University of Iowa, Iowa City.

The biofeedback program began with diaphragmatic breathing exercises, followed by weekly sessions using visual and verbal techniques aimed at improving anorectal coordination and sensory conditioning. Patients also practiced expelling an artificial stool made of silicone.

Moreover, 75% of patients noted significantly decreased straining in self-maintained defecation diaries. Self-reported stool frequency climbed from 4.2 per week at baseline to 7.2 per week at 1 year. Overall, 75% of patients expressed satisfaction with their bowel function, said Dr. Rao of the University of Iowa, Iowa City.

The diagnosis can often be made without manometry, Dr. Rao said. When a patient complains of straining with bowel movements, hard stools, infrequent defecation, and a feeling of incomplete evacuation, simply do a rectal exam and have the patient bear down on the finger in the rectum. If there is an increase in intraabdominal pressure as the finger is pushed out, along with relaxation of the anal sphincter, it's highly unlikely the patient has significant dyssynergic defecation.