Biofeedback is an effective treatment for patients with dyssynergic defaecation.
BACKGROUND
Constipation is a common affliction affecting the general population, with dyssynergic defaecation accounting for a large proportion of tertiary referrals. We sought to review the results of our patients with dyssynergic defaecation treated with biofeedback therapy in order to determine its efficacy.


METHODS
All patients who were referred to the anorectal physiology laboratory of our tertiary unit for biofeedback therapy for dyssynergic defaecation were reviewed. Patients diagnosed with secondary constipation and slow-transit constipation were excluded. A defaecating proctogram was used to exclude anatomical abnormalities causing outlet obstruction. Patients underwent a four-session, structured biofeedback exercise programme under the supervision of trained nurses. The effectiveness of biofeedback treatment was assessed using the validated Eypasch's Gastrointestinal Quality of Life Index (GIQLI).


RESULTS
226 patients (85 male, 141 female; median age 48 years) underwent biofeedback treatment. Post treatment, improvement was observed in the overall total score of the GIQLI, with gastrointestinal symptom (68.6%), emotion (61.0%) and physical function (57.9%) components showing the most improvement. These improvements were also reflected in the mean scores of each component and the mean total score. All components, except for social function and medication, and the overall total score showed significant improvement post treatment. At the one-year follow-up, 160 (71%) patients reported that improvements were maintained.


CONCLUSIONS
Biofeedback is an effective treatment for patients with dyssynergic defaecation. Patients with chronic constipation not improved by fibre and laxatives should be referred to a tertiary centre with facilities for further anorectal physiological assessment.
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Dennis
D
Koh
Jit-Fong
JF
Lim
Hak-Mien
HM
Quah
Choong-Leong
CL
Tang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001259:Ataxia / Q000628:therapy; D001676:Biofeedback, Psychology / Q000379:methods*; D002648:Child; D003248:Constipation / Q000628:therapy*; D003672:Defecation / Q000502:physiology*; D004644:Emotions; D005260:Female; D005762:Gastroenterology / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D016896:Treatment Outcome