Biofeedback effectively improves functional defecation disorder symptoms, finds study

A new study published in the journal of Neurogasteroenterology & Motility showed biofeedback (BF), which is still the cornerstone treatment option for refractory dyssynergic defecation (DD), to be an effective short-term cure for constipation in over 63% of patients. The symptoms of infrequent bowel movements and/or impaired rectal ejection are indicative of chronic constipation (CC). Up to 11.7% of individuals globally suffer with CC, which is one of the most frequent reasons for a gastroenterologist to be consulted. One major cause of refractory chronic constipation (CC) is functional defecation disorders (FDD). Diagnostic studies such as anorectal manometry (ARM) and balloon expulsion test (BET) are necessary for the diagnosis of FDD (dyssynergic defecation [DD] and insufficient defecatory propulsion [IDP]).

For DD, biofeedback (BF) is the preferred therapy. Thus, Christian Lambiase and team set out to assess the effectiveness of 2 basic diagnostic tests in short-term prediction of BF outcome, and the outcome of BF in a sample of constipated individuals with defecatory problems of any cause.

BF treatment was administered to 111 refractory CC patients who failed the BET. Prior to BF, every patient had the following procedures: ARM, Questionnaire on Straining, "Belly muscles," "anal muscles," "both," and "Don't know/No answer" were the responses. Abdominal palpation during straining was used to enhance digital rectal examination (augmented-DRE). The results of the augmented-DRE, straining questionnaire, and ARM were not visible to the BF therapist.

To BF, 81 patients answered. Age, gender, and IBS-C had no discernible effects on BF response. While the incidence of response was lower (p<0.001) in individuals with isolated structural pelvic floor problems, both DD and IDP reacted equally to BF. The "anal muscles" response was strongly correlated with the BF reaction (p<0.001) in the straining questionnaire. On augmented-DRE, a lack of anal relaxation and abdominal contraction was highly correlated with BF response (p<0.01). The BF reaction was linked to the lack of manual defecation techniques (p<0.001).

Overall, for refractory constipation caused by FDD of any cause, BF is the recommended treatment since it improves anorectal physiology and clinical symptoms in the near term. While symptomatic isolated pelvic floor problems seemed resistant to behavior therapy, comorbid IBS-C had no effect on the result. By encouraging early referral to BF, the straining questionnaire and augmented-DRE results demonstrated a good association with BF response and can be used in clinical practice to improve the management of constipated patients.

Source:

Lambiase, C., Bellini, M., Whitehead, W. E., Popa, S. L., Morganti, R., & Chiarioni, G. (2024). Biofeedback efficacy for outlet dysfunction constipation: Clinical outcomes and predictors of response by a limited approach. In Neurogastroenterology & Motility. Wiley. https://doi.org/10.1111/nmo.14948