title: Long-term study on the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and slow-transit constipation.
abstract: OBJECTIVE
  Biofeedback training has been shown as an effective therapeutic measure in patients with pelvic floor dyssynergia, at least in the short term. Long-term effects have received less attention. Moreover, its effects in patients with slow-transit constipation have been scarcely investigated. This study was designed to assess in an objective way the medium- and long-term effects of biofeedback and muscle training in patients with pelvic floor dyssynergia and slow-transit constipation.
  
  
  METHODS
  Twenty-four patients (14 with pelvic floor dyssynergia and 10 with slow transit) meeting the Rome II criteria for constipation, and unresponsive to conventional treatments, entered the study. Clinical evaluation and anorectal manometry were performed basally and three months after a cycle of electromyographic biofeedback and muscle training; moreover, a clinical interview was obtained one year after biofeedback. Patients with slow-transit constipation also had colonic transit time reassessed at one year.
  
  
  RESULTS
  Clinical variables (abdominal pain, straining, number of evacuations/week, use of laxatives) all significantly improved in both groups at three-month assessment; anorectal manometric variables remained unchanged, apart from a significant decrease of sensation threshold in the pelvic floor dyssynergia group and of the maximum rectal tolerable volume in the slow-transit constipation group. At one-year control, 50 percent of patients with pelvic floor dyssynergia still maintained a beneficial effect from biofeedback, whereas only 20 percent of those complaining of slow-transit constipation did so. Moreover, the latter displayed no improvement in colonic transit time.
  
  
  CONCLUSIONS
  In our experience, patients with pelvic floor dyssynergia are likely to have continued benefit from biofeedback training in the time course, whereas its effects on slow-transit constipation seems to be maximal in the short-term course.
authors.affiliation: Servizio di Endoscopia e Motilità Intestinale, Cattedra di Medicina Interna, Dipartimento di Fisiopatologia Clinica, Università di Torino, Torino, Italy.
authors.forename: Edda
authors.initials: E
authors.lastname: Battaglia
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Serra
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Buonafede
authors.forename: Luca
authors.initials: L
authors.lastname: Dughera
authors.forename: Fabio
authors.initials: F
authors.lastname: Chistolini
authors.forename: Antonio
authors.initials: A
authors.lastname: Morelli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Emanuelli
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
mesh_terms: D000328:Adult; D001259:Ataxia / Q000503:physiopathology / Q000628:therapy*; D001676:Biofeedback, Psychology; D003248:Constipation / Q000503:physiopathology / Q000628:therapy*; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D017773:Pelvic Floor / Q000503:physiopathology*; D011597:Psychomotor Performance / Q000502:physiology; D012007:Rectum / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome