09/01/05 11:26 AM
Biofeedback Helpful in Outlet Dysfunction Constipation

Biofeedback Helpful in Outlet Dysfunction Constipation

By David Douglas

NEW YORK (Reuters Health) Aug 16 - Biofeedback training appears useful in improving the symptoms of constipation due to difficulty in evacuating the rectum, according to Italian and US researchers.

As lead investigator Dr. Giuseppe Chiarioni told Reuters Health, "In our open study we were able to show that unresponsive constipation with slowed colon transit secondary to paradoxical contraction of the pelvic floor on straining -- so-called pelvic floor dyssynergia -- may be successfully treated by biofeedback therapy. "

In the July issue of Gastroenterology, Dr. Chiarioni of the University of Verona and colleagues note that they evaluated the approach in 52 patients all of whom had delayed whole gut transit.

In total, 34 of the subjects had pelvic floor dyssynergia, 12 had slow transit only and 6 met only 1 of 2 criteria for pelvic floor dyssynergia. These two criteria were paradoxical pelvic floor contraction during attempted defecation, and inability to evacuate a 50 ml water-filled balloon within 5 minutes of rectal placement.

All received five weekly biofeedback sessions directed at increasing rectal pressure and relaxing pelvic floor muscles during straining as well as practice in defecating the balloon.

At 6 months, 71% of the pelvic floor dyssynergia group reported satisfaction and 76% reported three or more bowel movements per week. However, only 8% of slow transit-only patients reported similar results.

Follow-up at 24 months showed that the improvements were maintained in the pelvic floor dyssynergia group.

The researchers conclude, "Our data suggest that, for outlet dysfunction constipation, at least, biofeedback does provide a specific benefit."

"Our study," Dr. Chiarioni added, "should prompt the development of teaching programs devoted to the training of skillful biofeedback therapists."

Gastroenterology 2005;129:86-97.


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