Research article summary (published 27 Feb 2007):

Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation.

Full Abstract

BACKGROUND &

AIMS:
Constipation is a common disorder, and current treatments are generally unsatisfactory. Biofeedback might help patients with constipation and dyssynergic defecation, but its efficacy is unproven, and whether improvements are due to operant conditioning or personal attention is unknown.

METHODS:
In a prospective randomized trial, we investigated the efficacy of biofeedback (manometric-assisted anal relaxation, muscle coordination, and simulated defecation training; biofeedback) with either sham feedback therapy (sham) or standard therapy (diet, exercise, laxatives; standard) in 77 subjects (69 women) with chronic constipation and dyssynergic defecation. At baseline and after treatment (3 months), physiologic changes were assessed by anorectal manometry, balloon expulsion, and colonic transit study and symptomatic changes and stool characteristics by visual analog scale and prospective stool diary. Primary outcome measures (intention-to-treat analysis) included presence of dyssynergia, balloon expulsion time, number of complete spontaneous bowel movements, and global bowel satisfaction.

RESULTS:
Subjects in the biofeedback group were more likely to correct dyssynergia (P < .0001), improve defecation index (P < .0001), and decrease balloon expulsion time (P = .02) than other groups. Colonic transit improved after biofeedback or standard (P = .01) but not after sham. In the biofeedback group, the number of complete spontaneous bowel movements increased (P < .02) and was higher (P < .05) than in other groups, and use of digital maneuvers decreased (P = .03). Global bowel satisfaction was higher (P = .04) in the biofeedback than sham group.

CONCLUSIONS:
Biofeedback improves constipation and physiologic characteristics of bowel function in patients with dyssynergia. This effect is mediated by modifying physiologic behavior and colorectal function. Biofeedback is the preferred treatment for constipated patients with dyssynergia.

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Author information

Author/s: Rao, Satish S C (SS); Seaton, Kara (K); Miller, Megan (M); Brown, Kice (K); Nygaard, Ingrid (I); Stumbo, Phyllis (P); Zimmerman, Bridgette (B); Schulze, Konrad (K);

Affiliation: University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. satish-rao(-atsign-)uiowa.edu

Grants: R01 DK 57100-05 (Agency:NIDDK NIH HHS) ; RR00059 (Agency:NCRR NIH HHS)

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural

Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol), published in United States. (Language: eng)

Reference: 2007-Mar; vol 5 (issue 3) : pp 331-8

Dates: Created 2007/03/19; Completed 2007/04/12; Revised 2008/03/20;

PMID: 17368232, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Clin Gastroenterol Hepatol. 2007 Sep;5(9):1119; author reply 1119. (PMID: 17825773)

CommentIn: Nat Clin Pract Gastroenterol Hepatol. 2008 Feb;5(2):74-5. (PMID: 18087300)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent Adult Aged Ataxia Biofeedback (Psychology) - methods Cathartics - therapeutic use Chronic Disease Constipation - diagnosis; therapy Defecation - physiology Defecography Female Follow-Up Studies

Gastrointestinal Motility Humans Male Manometry Middle Aged Probability Prospective Studies Rectum - innervation Reference Values Risk Assessment Severity of Illness Index Treatment Outcome

Associated Chemicals: Cathartics (0)

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