title: Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial.
abstract: OBJECTIVE
  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 1-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 (VASs), colonic transit, anorectal manometry, and balloon expulsion time were assessed at baseline, and at 1 year after each treatment. All subjects were seen at 3-month intervals and received reinforcement. Primary outcome measure (intention-to-treat analysis) was a change in the number of complete spontaneous bowel movements (CSBMs) 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 1 year; 6 failed standard therapy. The number of CSBMs per week increased significantly (P<0.001) in the biofeedback group 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, whereas standard therapy was largely ineffective.
authors.affiliation: Department of Gastroenterology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1009, USA. satish-rao@uiowa.edu
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
authors.forename: Jessica
authors.initials: J
authors.lastname: Valestin
authors.forename: C Kice
authors.initials: CK
authors.lastname: Brown
authors.forename: Bridget
authors.initials: B
authors.lastname: Zimmerman
authors.forename: Konrad
authors.initials: K
authors.lastname: Schulze
mesh_terms: D001676:Biofeedback, Psychology; D003248:Constipation / Q000503:physiopathology / Q000628:therapy*; D004035:Diet Therapy; D005081:Exercise Therapy; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D054368:Laxatives