From the Guidelines
Biofeedback therapy is highly recommended as a first-line treatment for patients with abnormal defecation associated with poor rectal propulsion, particularly in cases of dyssynergic defecation, as it has been shown to be effective in retraining the coordination between abdominal, rectal, and anal sphincter muscles during defecation, with success rates ranging from 70-80% in specialized centers, as noted in the most recent study 1. This therapy involves retraining the coordination between abdominal, rectal, and anal sphincter muscles during defecation. A typical biofeedback program consists of 6-8 sessions over 3 months, with each session lasting 45-60 minutes. During these sessions, patients receive visual or auditory feedback about their muscle activity through sensors placed in the rectum and on the abdominal wall, helping them learn proper coordination patterns. The therapy teaches patients to increase intra-abdominal pressure while simultaneously relaxing the pelvic floor muscles to facilitate stool passage. Key points to consider when implementing biofeedback therapy include:
- Combining biofeedback with proper toileting posture education (using a footstool, leaning forward)
- Ensuring adequate fiber intake (25-30g daily)
- Sufficient hydration
- Regular practice of the learned techniques between sessions is essential for successful outcomes, as emphasized in 1 and 1. The therapy works by reestablishing normal neuromuscular pathways through operant conditioning, essentially helping patients relearn the proper defecation process that has become dyscoordinated, with the most recent evidence supporting its effectiveness in improving health-related quality of life and reducing healthcare costs 1.
From the Research
Role of Biofeedback Therapy in Treating Abnormal Defecation
- Biofeedback therapy is effective in managing pelvic floor disorders, including defecatory disorders and fecal incontinence 2
- It has been shown to be superior to laxatives for normal transit constipation due to pelvic floor dyssynergia, with benefits lasting at least 2 years 3
- Biofeedback therapy can improve symptoms of constipation, such as straining, sensations of incomplete evacuation, and anorectal blockage, and can also increase stool frequency 3
Mechanism of Biofeedback Therapy
- Biofeedback therapy involves training patients to become aware of and control their pelvic floor muscles, which can help to improve rectal propulsion and defecation 4, 5
- It can be performed using various techniques, including anal strength, endurance, and coordination training, as well as electrical stimulation and voice-guided instructions 4
Efficacy of Biofeedback Therapy
- Studies have shown that biofeedback therapy can be effective in treating fecal incontinence, with success rates ranging from 60-80% 4, 5
- It can also be effective in treating constipation, particularly in patients with pelvic floor dysfunction, with success rates ranging from 50-77% 3, 5
- Biofeedback therapy has been shown to be safe and effective, with minimal risk and discomfort, and can be a cost-effective option for patients with functional proctologic disorders 6
Patient Selection and Response to Biofeedback Therapy
- Patients with a lower bowel satisfaction score and those who use digital maneuvers may fare better with biofeedback therapy 2
- Biofeedback therapy is recommended for patients with fecal incontinence who do not respond to conservative management, and for patients with levator ani syndrome who have dyssynergic defecation 2