Can biofeedback therapy change discomfort anorectal sensations to more acceptable or even pleasurable sensations in a patient with a history of anorectal surgery and neurogenic symptoms?

Can Biofeedback Therapy Restore Comfortable or Pleasurable Anorectal Sensations?

Biofeedback therapy can improve abnormal anorectal sensations, including rectal hypersensitivity and hyposensitivity, with success rates exceeding 70%, though the goal is restoration of normal sensation and function rather than "pleasurable" sensations. 1

Understanding What Biofeedback Can and Cannot Do

Biofeedback therapy specifically addresses rectal sensory dysfunction identified through anorectal manometry, including both hyposensitivity (reduced sensation) and hypersensitivity (excessive discomfort with normal distension). 2, 1

The mechanism works through:

• Sensory retraining that helps patients recognize and respond appropriately to rectal filling 1
• Sensory adaptation training for hypersensitivity, helping patients tolerate normal rectal distension without excessive discomfort 1
• Rectal sensorimotor coordination training that improves the sensation-motor mismatch causing urgency and discomfort 1

Evidence for Sensory Improvement

The American Gastroenterological Association reports that biofeedback therapy improves:

• Rectal hypersensitivity (excessive discomfort) through adaptation training 2, 1
• Rectal hyposensitivity (reduced sensation) through sensory perception training 1
• Threshold volumes for first perception and desire to defecate, which decreased significantly after therapy 3

One study demonstrated that threshold volumes for first perception and desire to defecate decreased (p < 0.05) after biofeedback, indicating improved sensory awareness. 3 Additionally, biofeedback improved abdominal distention, rectal hypersensitivity, and bloating with a 54% responder rate for bloating scores decreased by 50%. 2

Realistic Expectations for Your Patient

For a patient with post-surgical anorectal dysfunction and neurogenic symptoms, biofeedback can:

• Reduce uncomfortable sensations associated with rectal distension 1, 3
• Improve awareness of rectal filling without excessive urgency or discomfort 1, 3
• Restore more normal sensation patterns rather than creating "pleasurable" sensations 1

Critical caveat: The goal is normalization of sensation and function, not creation of pleasurable sensations. The therapy addresses pathological discomfort by restoring normal rectoanal coordination and sensory thresholds. 1, 3

Prerequisites for Success

Before proceeding, ensure:

• Anorectal manometry confirms the specific sensory abnormality (hyposensitivity vs. hypersensitivity) 2, 1
• Some degree of rectal sensation is present—complete absence of sensation predicts poor response 4, 5
• Patient motivation is adequate—biofeedback requires time commitment and active participation 4, 5

Treatment Algorithm

1. Confirm sensory dysfunction through anorectal manometry showing abnormal threshold volumes or sensation 2, 1
2. Initiate biofeedback therapy with 6 weekly sessions using instrumented visual monitoring 2, 6
3. Expect 70-80% success rate for properly selected patients with dyssynergic defecation 1, 6
4. Provide reinforcement sessions at 6 weeks, 3,6, and 12 months to maintain gains 3

Common Pitfalls to Avoid

• Do not skip anorectal testing—sensory dysfunction must be objectively documented before therapy 2, 1
• Do not expect immediate results—sensory retraining requires the full 6-session protocol with reinforcement 3
• Do not proceed if rectal sensation is completely absent—this predicts treatment failure 4, 5
• Do not confuse symptom improvement with "pleasurable" sensations—the goal is comfortable, normal function 1

Alternative if Biofeedback Fails

If adequate biofeedback trial (6 sessions with proper technique) fails to improve sensory symptoms, sacral nerve stimulation may improve rectal sensation in select patients with rectal hyposensitivity, though evidence for functional improvement remains limited. 1 However, this should only be considered after biofeedback, not as first-line therapy. 1, 6

Safety Profile

Biofeedback is completely free of morbidity and safe for long-term use, making it the preferred first-line approach for sensory dysfunction. 1, 5