Biofeedback best for common type of constipation

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Study findings indicate that biofeedback is far more effective than laxatives in relieving constipation caused by inappropriate contraction or inability to relax the pelvic floor muscles during defecation—what doctors call “pelvic floor dyssynergia.”

“Biofeedback should become the treatment of choice for this common and easily diagnosed type of constipation,” the investigators conclude.

In a randomized, controlled trial, Dr. Giuseppe Chiarioni from the University of Verona in Italy and an international team compared the effects of five weekly 30-minute biofeedback sessions with one of the most effective laxatives (polyethylene glycol) plus constipation prevention counseling.

Biofeedback training included teaching subjects to strain more effectively, to coordinate expulsion efforts with their breathing and to relax pelvic floor muscles.

The study involved 109 patients (all but five of whom were women) with constipation due to chronic severe pelvic floor dyssynergia who had failed attempts to relieve constipation with 20 grams per day of fiber plus enemas or suppositories up to twice weekly.

Biofeedback, Chiarioni told Reuters Health, proved “highly effective in determining a long lasting improvement in constipation symptoms and anorectal function in the majority of patients. Continuous laxatives, on the other hand, were marginally effective in a minority of patients.”

Specifically, at 6 months 80 percent of the biofeedback group had “major improvement” in constipation compared with just 22 percent of the laxative group. The benefits of biofeedback were still evident at 2 years, the team reports.

Compared with laxatives, biofeedback produced greater reductions in straining, sensations of incomplete evacuation, and blockage, use of enemas and suppositories and abnormal pain, according to a report of the study in Gastroenterology. Stool frequency increased in both treatment arms.

Pelvic floor dyssynergia is one of the most disabling subtypes of constipation. “Our findings should prompt physicians to search for this common subtype of functional constipation to avoid treating affected patients with a poorly effective therapy (laxatives),” Dr. Chiarioni told Reuters Health.

SOURCE: Gastroenterology March 2006.

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I’ve read all the Chiaroni papers and found them quite fascinating.  The electronic set up was the most innovative.  Basically they had to place an electrical read out device in the lower rectum to record responses in the muscles.

posted by adam on 10/30/2009 at 9:57 pm -08:00