What information should a patient with a history of anorectal surgery and neurogenic symptoms, experiencing rectal hypersensitivity or hyposensitivity, communicate to a pelvic care therapist to be taken seriously for biofeedback treatment unrelated to incontinence issues?

Communicating Your Need for Biofeedback Therapy Beyond Incontinence

You should explicitly state to your pelvic care therapist that you have rectal sensory abnormalities (either hypersensitivity or hyposensitivity) following anorectal surgery, and that biofeedback therapy has established evidence for treating these specific sensory disorders independent of incontinence. 1

Key Points to Emphasize in Your Discussion

Lead with Your Specific Sensory Dysfunction

• State clearly whether you experience rectal hypersensitivity or hyposensitivity, as these are distinct, recognized indications for biofeedback therapy that exist completely separate from incontinence treatment 1
• Explain that you have neurogenic symptoms following anorectal surgery, which is a known etiological factor for rectal sensory dysfunction 2, 3
• Mention that 38% of patients with rectal hyposensitivity have a history of pelvic surgery, and 22% have a history of anal surgery, establishing surgical trauma as a validated cause of sensory abnormalities 2

Cite the Established Evidence Base

• Biofeedback therapy is specifically indicated for rectal hyposensitivity training in patients with constipation through sensory retraining techniques 1
• Sensory adaptation training can treat rectal hypersensitivity as a distinct therapeutic application 1
• Rectal sensorimotor coordination training improves rectal urgency in patients with sensory dysfunction, regardless of incontinence status 1
• The American Neurogastroenterology and Motility Society gave biofeedback therapy a Grade A recommendation for dyssynergic defecation, which frequently coexists with sensory abnormalities 1

Frame Your Symptoms in Clinical Terms

If you have rectal hyposensitivity, describe:

• Difficulty sensing rectal fullness or the urge to defecate 2, 3
• Constipation symptoms where you cannot tell when you need to evacuate 2, 3
• That rectal hyposensitivity may be the only identifiable abnormality on physiologic testing in 48% of patients with constipation 2

If you have rectal hypersensitivity, describe:

• Exaggerated stool frequency and urgency 4
• Heightened awareness of rectal sensations that interfere with daily function 4
• That approximately 50% of patients with urge symptoms have rectal hypersensitivity as the primary driver 4

Address Common Misconceptions Directly

• Clarify that biofeedback is not just for incontinence—it has multiple therapeutic applications including sensory retraining, coordination training, and treatment of evacuation disorders 1
• Explain that sensory abnormalities warrant additional assessment and treatment according to recent consensus guidelines, even when sphincter function is normal 1
• Note that "sensory-retraining biofeedback" is the most effective treatment for rectal hyposensitivity, with objective improvement in rectal sensory function 3

Request Specific Diagnostic Confirmation

• Ask whether anorectal manometry (ARM) with rectal sensation testing has been performed to objectively document your sensory abnormality 1
• If not already done, request that sensory threshold volumes be measured during balloon distension to establish baseline rectal sensitivity 2, 3
• Emphasize that consensus guidelines recommend using more than one sensory assessment to define sensory conditions given their subjective nature 1

Critical Pitfalls to Avoid

• Do not frame your request solely around bowel movement difficulties—this may inadvertently redirect focus to incontinence or constipation management rather than the underlying sensory dysfunction 1
• Do not accept dismissal based on normal sphincter pressures—sensory abnormalities are independent pathologies that require separate treatment 2, 3
• Avoid vague descriptions of symptoms—use specific clinical terminology like "rectal hyposensitivity," "sensory threshold abnormalities," or "impaired rectal sensation" 1, 2, 3

Supporting Your Case with Documentation

• If you have prior anorectal manometry results showing elevated or reduced sensory thresholds, bring these to your appointment 2, 3
• Document your surgical history in detail, as pelvic nerve injury from surgery is a recognized etiological factor for sensory dysfunction 2, 3
• Note that pelvic radiotherapy causes neorectal hyposensitivity if you have had radiation treatment, establishing another validated mechanism 5