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Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia.

Abstract

BACKGROUND & AIMS

Uncontrolled trials suggest biofeedback is an effective treatment for pelvic floor dyssynergia (PFD), a type of constipation defined by paradoxical contraction, or inability to relax, pelvic floor muscles during defecation. The aim was to compare biofeedback to laxatives plus education.

METHODS

Patients with chronic, severe PFD were first treated with 20 g/day fiber plus enemas or suppositories up to twice weekly. Nonresponders were randomized to either 5 weekly biofeedback sessions (n = 54) or polyethylene glycol 14.6-29.2 g/day plus 5 weekly counseling sessions in preventing constipation (n = 55). Satisfaction with treatment, symptoms of constipation, and pelvic floor physiology were assessed 6 and 12 months later. The biofeedback group was also assessed at 24 months. Laxative-treated patients were instructed to increase the dose of polyethylene glycol from 14.6 to 29.2 g/day after 6 months.

RESULTS

At 6 months, major improvement was reported by 43 of 54 (80%) biofeedback patients vs 12 of 55 (22%) laxative-treated patients (P < .001). Biofeedback's benefits were sustained at 12 and 24 months. Biofeedback also produced greater reductions in straining, sensations of incomplete evacuation and anorectal blockage, use of enemas and suppositories, and abdominal pain (all P < .01). Stool frequency increased in both groups. All biofeedback-treated patients reporting major improvement were able to relax the pelvic floor and defecate a 50-mL balloon at 6 and 12 months.

CONCLUSIONS

Five biofeedback sessions are more effective than continuous polyethylene glycol for treating PFD, and benefits last at least 2 years. Biofeedback should become the treatment of choice for this common and easily diagnosed type of constipation.

Authors+Show Affiliations

,

Gastrointestinal Rehabilitation Division, Valeggio sul Mincio Hospital, Azienda Ospedaliera and University of Verona, Verona, Italy.

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Source

Gastroenterology 130:3 2006 Mar pg 657-64

MeSH

Adult
Biofeedback, Psychology
Cathartics
Constipation
Female
Gastrointestinal Transit
Humans
Male
Patient Compliance
Pelvic Floor

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

16530506

Citation

Chiarioni, Giuseppe, et al. "Biofeedback Is Superior to Laxatives for Normal Transit Constipation Due to Pelvic Floor Dyssynergia." Gastroenterology, vol. 130, no. 3, 2006, pp. 657-64.
Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130(3):657-64.
Chiarioni, G., Whitehead, W. E., Pezza, V., Morelli, A., & Bassotti, G. (2006). Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology, 130(3), pp. 657-64.
Chiarioni G, et al. Biofeedback Is Superior to Laxatives for Normal Transit Constipation Due to Pelvic Floor Dyssynergia. Gastroenterology. 2006;130(3):657-64. PubMed PMID: 16530506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. AU - Chiarioni,Giuseppe, AU - Whitehead,William E, AU - Pezza,Vincenzo, AU - Morelli,Antonio, AU - Bassotti,Gabrio, PY - 2005/08/30/received PY - 2005/11/09/accepted PY - 2006/3/15/pubmed PY - 2006/4/7/medline PY - 2006/3/15/entrez SP - 657 EP - 64 JF - Gastroenterology JO - Gastroenterology VL - 130 IS - 3 N2 - BACKGROUND & AIMS: Uncontrolled trials suggest biofeedback is an effective treatment for pelvic floor dyssynergia (PFD), a type of constipation defined by paradoxical contraction, or inability to relax, pelvic floor muscles during defecation. The aim was to compare biofeedback to laxatives plus education. METHODS: Patients with chronic, severe PFD were first treated with 20 g/day fiber plus enemas or suppositories up to twice weekly. Nonresponders were randomized to either 5 weekly biofeedback sessions (n = 54) or polyethylene glycol 14.6-29.2 g/day plus 5 weekly counseling sessions in preventing constipation (n = 55). Satisfaction with treatment, symptoms of constipation, and pelvic floor physiology were assessed 6 and 12 months later. The biofeedback group was also assessed at 24 months. Laxative-treated patients were instructed to increase the dose of polyethylene glycol from 14.6 to 29.2 g/day after 6 months. RESULTS: At 6 months, major improvement was reported by 43 of 54 (80%) biofeedback patients vs 12 of 55 (22%) laxative-treated patients (P < .001). Biofeedback's benefits were sustained at 12 and 24 months. Biofeedback also produced greater reductions in straining, sensations of incomplete evacuation and anorectal blockage, use of enemas and suppositories, and abdominal pain (all P < .01). Stool frequency increased in both groups. All biofeedback-treated patients reporting major improvement were able to relax the pelvic floor and defecate a 50-mL balloon at 6 and 12 months. CONCLUSIONS: Five biofeedback sessions are more effective than continuous polyethylene glycol for treating PFD, and benefits last at least 2 years. Biofeedback should become the treatment of choice for this common and easily diagnosed type of constipation. SN - 0016-5085 UR - https://www.unboundmedicine.com/medline/citation/16530506/Biofeedback_is_superior_to_laxatives_for_normal_transit_constipation_due_to_pelvic_floor_dyssynergia_ DB - PRIME DP - Unbound Medicine ER -