Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial - PubMed (original) (raw)

Randomized Controlled Trial

Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial

Satish S C Rao et al. Am J Gastroenterol. 2010 Apr.

Abstract

Objectives: 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.

PubMed Disclaimer

Conflict of interest statement

Competing Interest: None.

Figures

Figure 1

Figure 1

Consort diagram of the long term clinical trial with biofeedback therapy.

Figure 2

Figure 2

This shows the number of complete spontaneous bowel movements per week in each of the two treatment groups, before and after treatment.

Figure 3

Figure 3

This shows the number of subjects who exhibited a dyssynergic pattern of defecation on anorectal manometry, before and after each treatment.

Figure 4

Figure 4

This shows the effect of each treatment on the balloon expulsion time in subjects with dyssynergic defecation.

Comment in

Similar articles

Cited by

References

    1. Mertz H, Naliboff B, Mayer E. Physiology of refractory chronic constipation. Am J Gastroenterol. 1999;94:609–15. - PubMed
    1. Koch A, Voderholzer WA, Klauser AG, et al. Symptoms in chronic constipation. Dis Colon Rectum. 1998;40:902–6. - PubMed
    1. Grotz RL, Pemberton JH, Talley NJ, et al. Discriminant value of psychological distress, symptom profiles, and segmental colonic dysfunction in outpatients with severe idiopathic constipation. Gut. 1994;35:798–802. - PMC - PubMed
    1. Surrenti E, Rath DM, Pemberton JH, et al. Audit of constipation in a tertiary referral gastroenterology practice. Am J Gastroenterol. 1995;90:1471–5. - PubMed
    1. Preston DM, Lennard-Jones J. Anismus in chronic constipation. Dig Dis Sci. 1985;30:413–8. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources