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Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation.

Abstract

BACKGROUND & AIMS

Constipation is a common disorder, and current treatments are generally unsatisfactory. Biofeedback might help patients with constipation and dyssynergic defecation, but its efficacy is unproven, and whether improvements are due to operant conditioning or personal attention is unknown.

METHODS

In a prospective randomized trial, we investigated the efficacy of biofeedback (manometric-assisted anal relaxation, muscle coordination, and simulated defecation training; biofeedback) with either sham feedback therapy (sham) or standard therapy (diet, exercise, laxatives; standard) in 77 subjects (69 women) with chronic constipation and dyssynergic defecation. At baseline and after treatment (3 months), physiologic changes were assessed by anorectal manometry, balloon expulsion, and colonic transit study and symptomatic changes and stool characteristics by visual analog scale and prospective stool diary. Primary outcome measures (intention-to-treat analysis) included presence of dyssynergia, balloon expulsion time, number of complete spontaneous bowel movements, and global bowel satisfaction.

RESULTS

Subjects in the biofeedback group were more likely to correct dyssynergia (P < .0001), improve defecation index (P < .0001), and decrease balloon expulsion time (P = .02) than other groups. Colonic transit improved after biofeedback or standard (P = .01) but not after sham. In the biofeedback group, the number of complete spontaneous bowel movements increased (P < .02) and was higher (P < .05) than in other groups, and use of digital maneuvers decreased (P = .03). Global bowel satisfaction was higher (P = .04) in the biofeedback than sham group.

CONCLUSIONS

Biofeedback improves constipation and physiologic characteristics of bowel function in patients with dyssynergia. This effect is mediated by modifying physiologic behavior and colorectal function. Biofeedback is the preferred treatment for constipated patients with dyssynergia.

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  • Authors+Show Affiliations

    ,

    University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. satish-rao@uiowa.edu

    , , , , , ,

    Source

    MeSH

    Adolescent
    Adult
    Aged
    Ataxia
    Biofeedback, Psychology
    Cathartics
    Chronic Disease
    Constipation
    Defecation
    Defecography
    Female
    Follow-Up Studies
    Gastrointestinal Motility
    Humans
    Male
    Manometry
    Middle Aged
    Probability
    Prospective Studies
    Rectum
    Reference Values
    Risk Assessment
    Severity of Illness Index
    Treatment Outcome

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    17368232

    Citation

    Rao, Satish S C., et al. "Randomized Controlled Trial of Biofeedback, Sham Feedback, and Standard Therapy for Dyssynergic Defecation." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 5, no. 3, 2007, pp. 331-8.
    Rao SS, Seaton K, Miller M, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5(3):331-8.
    Rao, S. S., Seaton, K., Miller, M., Brown, K., Nygaard, I., Stumbo, P., ... Schulze, K. (2007). Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 5(3), pp. 331-8.
    Rao SS, et al. Randomized Controlled Trial of Biofeedback, Sham Feedback, and Standard Therapy for Dyssynergic Defecation. Clin Gastroenterol Hepatol. 2007;5(3):331-8. PubMed PMID: 17368232.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. AU - Rao,Satish S C, AU - Seaton,Kara, AU - Miller,Megan, AU - Brown,Kice, AU - Nygaard,Ingrid, AU - Stumbo,Phyllis, AU - Zimmerman,Bridgette, AU - Schulze,Konrad, PY - 2007/3/21/pubmed PY - 2007/4/14/medline PY - 2007/3/21/entrez SP - 331 EP - 8 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 5 IS - 3 N2 - BACKGROUND & AIMS: Constipation is a common disorder, and current treatments are generally unsatisfactory. Biofeedback might help patients with constipation and dyssynergic defecation, but its efficacy is unproven, and whether improvements are due to operant conditioning or personal attention is unknown. METHODS: In a prospective randomized trial, we investigated the efficacy of biofeedback (manometric-assisted anal relaxation, muscle coordination, and simulated defecation training; biofeedback) with either sham feedback therapy (sham) or standard therapy (diet, exercise, laxatives; standard) in 77 subjects (69 women) with chronic constipation and dyssynergic defecation. At baseline and after treatment (3 months), physiologic changes were assessed by anorectal manometry, balloon expulsion, and colonic transit study and symptomatic changes and stool characteristics by visual analog scale and prospective stool diary. Primary outcome measures (intention-to-treat analysis) included presence of dyssynergia, balloon expulsion time, number of complete spontaneous bowel movements, and global bowel satisfaction. RESULTS: Subjects in the biofeedback group were more likely to correct dyssynergia (P < .0001), improve defecation index (P < .0001), and decrease balloon expulsion time (P = .02) than other groups. Colonic transit improved after biofeedback or standard (P = .01) but not after sham. In the biofeedback group, the number of complete spontaneous bowel movements increased (P < .02) and was higher (P < .05) than in other groups, and use of digital maneuvers decreased (P = .03). Global bowel satisfaction was higher (P = .04) in the biofeedback than sham group. CONCLUSIONS: Biofeedback improves constipation and physiologic characteristics of bowel function in patients with dyssynergia. This effect is mediated by modifying physiologic behavior and colorectal function. Biofeedback is the preferred treatment for constipated patients with dyssynergia. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/17368232/Randomized_controlled_trial_of_biofeedback_sham_feedback_and_standard_therapy_for_dyssynergic_defecation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(06)01321-8 DB - PRIME DP - Unbound Medicine ER -