Prospective study of biofeedback treatment for patients with slow and normal transit constipation

Objective To assess biofeedback training as treatment in a consecutive series of patients with idiopathic constipation. Design Symptomatic and physiological assessment before and after treatment. Methods Assessment included a record of symptoms by diary card, measurement of whole gut transit time, defecation proctography and anorectal function tests. During training sessions, muscular activity of the pelvic floor was displayed to the patient as an electromyographic trace. The patient was taught to recognize resting electrical activity and the increase associated with voluntary contraction of the pelvic floor. If there was an increase (rather than the normal decrease) in activity during defecation straining, the patient was encouraged to strain while maintaining relaxation of the anal sphincter muscles. Patients were assessed at the end of treatment, after 6 weeks and after 6–12 months. Results Two types of pelvic incoordination were observed: an inability to relax the pelvic floor on defecation straining and an inability to strain effectively, both types improved with training. Of the 20 out of 30 unselected patients who completed training, there was significant improvement in bowel frequency, and a decrease in the number and duration of straining episodes at every follow-up period. Patients recorded significant overall perception of symptoms at each period; abdominal pain and bloating improved at 6 weeks and 6–12 months. Conclusion Approximately 50% of the consecutive series of patients with constipation were helped by two to six biofeedback training sessions. The improvement persisted for at least 6–12 months.