Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation.
OBJECTIVE
Constipation is a common disorder, and current treatments are generally unsatisfactory. Biofeedback might help patients with constipation and dyssynergic defecation, but its efficacy is unproven, and whether improvements are due to operant conditioning or personal attention is unknown.


METHODS
In a prospective randomized trial, we investigated the efficacy of biofeedback (manometric-assisted anal relaxation, muscle coordination, and simulated defecation training; biofeedback) with either sham feedback therapy (sham) or standard therapy (diet, exercise, laxatives; standard) in 77 subjects (69 women) with chronic constipation and dyssynergic defecation. At baseline and after treatment (3 months), physiologic changes were assessed by anorectal manometry, balloon expulsion, and colonic transit study and symptomatic changes and stool characteristics by visual analog scale and prospective stool diary. Primary outcome measures (intention-to-treat analysis) included presence of dyssynergia, balloon expulsion time, number of complete spontaneous bowel movements, and global bowel satisfaction.


RESULTS
Subjects in the biofeedback group were more likely to correct dyssynergia (P < .0001), improve defecation index (P < .0001), and decrease balloon expulsion time (P = .02) than other groups. Colonic transit improved after biofeedback or standard (P = .01) but not after sham. In the biofeedback group, the number of complete spontaneous bowel movements increased (P < .02) and was higher (P < .05) than in other groups, and use of digital maneuvers decreased (P = .03). Global bowel satisfaction was higher (P = .04) in the biofeedback than sham group.


CONCLUSIONS
Biofeedback improves constipation and physiologic characteristics of bowel function in patients with dyssynergia. This effect is mediated by modifying physiologic behavior and colorectal function. Biofeedback is the preferred treatment for constipated patients with dyssynergia.
Rao
Satish S C
SS
University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. satish-rao@uiowa.edu
Seaton
Kara
K
Miller
Megan
M
Brown
Kice
K
Nygaard
Ingrid
I
Stumbo
Phyllis
P
Zimmerman
Bridgette
B
Schulze
Konrad
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D001259:Ataxia; D001676:Biofeedback, Psychology / Q000379:methods*; D002400:Cathartics / Q000627:therapeutic use; D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis / Q000628:therapy*; D003672:Defecation / Q000502:physiology; D019841:Defecography; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012007:Rectum / Q000294:innervation; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D002400:Cathartics