title: The effect of biofeedback therapy on dyssynergic constipation in patients with or without Irritable Bowel Syndrome.
abstract: BACKGROUND
  The Rome II and III diagnostic criteria for dyssynergic defecation recommended the exclusion of irritable bowel syndrome (IBS). This study determined the effect of biofeedback therapy on dyssynergic constipation in patients with or without IBS.
  
  
  METHODS
  This study was a nonrandomized, single blinded, semi experimental study. Dyssynergic defecation patients with and without IBS were asked to undergo biofeedback therapy 8 sessions. The defecation dynamics and balloon expulsion time were evaluated before, at the end and 1 month after the biofeedback therapy. IBS symptoms were graded using a 4-point Likert scale. Mann-Whitney U-test, Wilcoxon test and Friedman test were applied to analyze data using SPSS software package (SPSS Inc., Chicago, IL, USA).
  
  
  RESULTS
  After the biofeedback therapy, the IBS symptoms have been decreased significantly (the median of 2 before and 1 after therapy, P < 0.01). The biofeedback therapy significantly decreased the anismus index in IBS group by the mean of 0.75 ± 0.31, 0.28 ± 0.07 and 0.28 ± 0.06 in three phases, respectively. Similar results were found in non-IBS patients (the mean of 0.74 ± 0.32, 0.28 ± 0.08, 0.27 ± 0.08 in three phases, respectively). The symptoms of constipation (sensation of incomplete evacuation, difficult and painful defecation), defecation facilitative manual maneuver frequency, pelvic floor muscles resting amplitude and strain amplitude decreased and squeezing amplitude improved significantly after biofeedback therapy in both groups with and without IBS (P < 0.001). There were not significant differences between patients with and without IBS (P > 0.05) with respect to outcome. No complication was observed in treatment groups.
  
  
  CONCLUSIONS
  Dyssynergic constipation patients with and without IBS will likely benefit from biofeedback therapy.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Iran University of Medical Science, Tehran, Iran.
authors.forename: Tannaz
authors.initials: T
authors.lastname: Ahadi
authors.affiliation: Department of Physical Medicine and Rehabilitation, Iran University of Medical Science, Tehran, Iran.
authors.forename: Faezeh
authors.initials: F
authors.lastname: Madjlesi
authors.affiliation: Department of Surgery, Iran University of Medical Science, Tehran, Iran.
authors.forename: Bahar
authors.initials: B
authors.lastname: Mahjoubi
authors.affiliation: Department of Surgery, Iran University of Medical Science, Tehran, Iran.
authors.forename: Rezvan
authors.initials: R
authors.lastname: Mirzaei
authors.affiliation: Department of Physical Medicine and Rehabilitation, Iran University of Medical Science, Tehran, Iran.
authors.forename: Bijan
authors.initials: B
authors.lastname: Forogh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Iran University of Medical Science, Tehran, Iran.
authors.forename: Seyedeh Somayeh
authors.initials: SS
authors.lastname: Daliri
authors.affiliation: Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Seyed Majid
authors.initials: SM
authors.lastname: Derakhshandeh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Iran University of Medical Science, Tehran, Iran.
authors.forename: Roxana Bazaz
authors.initials: RB
authors.lastname: Behbahani
authors.affiliation: Department of Physical Medicine and Rehabilitation, Iran University of Medical Science, Tehran, Iran.
authors.forename: G Reza
authors.initials: GR
authors.lastname: Raissi
keywords: Biofeedback; dyssynergic constipation; irritable bowel syndrome