Biofeedback may ease chronic constipation

Biofeedback training can have long-lasting benefits in people who suffer from chronic constipation due to a condition called "dyssynergic defecation," new research indicates.

People with this condition have difficulty emptying their bowels because the muscles in their rectum and anus are out of sync. Consequently, when they attempt a bowel movement, their bowels empty incompletely or not all. Biofeedback teaches patients how to get their bowel and anal muscles to work normally to produce a complete and satisfactory evacuation.

Dr. Satish Rao and colleagues at the University of Iowa Hospitals and Clinics in Iowa City, found that biofeedback using sensors monitoring the bowel and anus can indeed help train adults with this type of chronic constipation to have normal bowel movements. While an earlier study by Rao's team showed a benefit at three months, their current study showed benefits lasting out to one year.

Rao, a gastroenterologist, told Reuters Health in a telephone interview that this particular type of chronic constipation has only been recognized over the past 15 years and affects more than 10 million Americans. For unexplained reasons, dyssynergic defecation occurs in twice as many women as men. The condition can interfere with a person's social life and ability to hold down a job.

"Dyssynergic defecation is grossly unrecognized and consequently not well-treated," Rao said. "Many doctors don't know about it or how to manage this problem."

The Iowa team compared the one-year outcome of biofeedback training with standard care in 26 chronically constipated patients with dyssynergic defecation. All of them received standard instruction regarding bowel habits, exercise and breathing techniques, use of laxatives, and the importance of eating a high-fiber diet. They were also encouraged to attempt a bowel movement 30 minutes after eating for five minutes twice a day irrespective of the urge to defecate.

Thirteen of the patients underwent six biofeedback sessions during the first three months and then reinforcing sessions at three-month intervals. During biofeedback training, a probe with sensors is inserted rectally. The sensor detects the muscle signals from the anus and rectum and displays them visually on a TV monitor. While sitting on the toilet, the subjects are able to see how these muscles are contracting or relaxing and with the visual feedback learn how to coordinate them to improve their push movements.

The biofeedback patients had a significant increase in normal bowel movements and normal bowel patterns, whereas no improvement occurred in the 13 control patients who did not receive biofeedback training, the researchers report in the American Journal of Gastroenterology.

In addition, roughly 30 percent of the biofeedback patients stopped taking laxatives, whereas none of the subjects in the control group stopped using laxatives at the one-year point.