Long-Term Efficacy of Biofeedback Therapy for Dyssynergic... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: FUNCTIONAL GI DISORDERS

Long-Term Efficacy of Biofeedback Therapy for Dyssynergic Defecation: Randomized Controlled Trial

Rao, Satish S C MD, PhD, FRCP (LON), FACG1; Valestin, Jessica BS1; Brown, Kice C MS2; Zimmerman, Bridget PhD3,4; Schulze, Konrad MD, FRCP1

1Department of Gastroenterology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA

2Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA

3Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA

4Department of Medicine and Institute for Clinical Translational Science, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA

Correspondence: Satish S.C. Rao, MD, PhD, FRCP (LON), Department of Gastroenterology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 4612 JCP, Iowa City, Iowa 52242-1009, USA. E-mail: [email protected]

published online 23 February 2010

Received 4 November 2009; accepted 3 February 2010

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.