Efficacy of a Modified Training Program of Adaptive Biofeedback Therapy for Dyssynergic Defecation in Patients with Chronic Constipation

Abstract Background Chronic constipation (CC) and fecal incontinence (FI) are often secondary to pelvic floor neuromuscular sensory or motor dysfunction. Biofeedback therapy (BFT) uses visual and verbal feedback to improve anorectal coordination, strength and sensation. In clinical trials, BFT demonstrated response rates between 70% and 80%. The purpose of this study is to determine the effectiveness of BFT in clinical practice. Methods In this retrospective observational cohort study, the charts of all patients who completed BFT at our centre were reviewed. A positive response to BFT was defined as improvement in ARM profile from baseline or subjective symptom improvement or both. Descriptive statistics were used to analyze the data. Results One hundred thirty patients with an average age of 57.5 ± 16.4 years and 79.2% female were included. Of all patients, 43.1% were referred for CC, 37.7% for FI, 16.9% for alternating CC and FI, and 2.3% for rectal pain. The overall response rate to BFT was 76.2% (n=99). Of those that responded, 64.6% (n=64) demonstrated both ARM and symptom improvement, 27.3% (n=27) had ARM improvement but no symptom improvement, and 8.1% (n=8) had symptom improvement but no ARM improvement. In patients with FI, the overall response rate was 79.6% (n=39) with symptom improvement in 67.3% (n=33). In those with CC with dyssynergic defecation (n=53), the overall response rate was 69.8% (n=37); however, only 45.3% (n=24) had symptomatic improvement. Conclusion In our clinical practice, although overall response rates to BFT are similar to published reports, patients with CC with dyssynergic defecation are less likely to have symptomatic response compared with those with FI.

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Prevalence and Clinical Characteristics of Dyssynergic Defecation and Slow Transit Constipation in Patients with Chronic Constipation

Journal of Clinical Medicine ◽

10.3390/jcm10092027 ◽

2021 ◽

Vol 10 (9) ◽

pp. 2027

Author(s):

Samuel Tanner ◽

Ahson Chaudhry ◽

Navneet Goraya ◽

Rohan Badlani ◽

Asad Jehangir ◽

...

Keyword(s):

Medical History ◽

Chronic Constipation ◽

Clinical Characteristics ◽

Anorectal Function ◽

Slow Transit Constipation ◽

Dyssynergic Defecation ◽

Patient Demographics ◽

Balloon Expulsion ◽

Slow Transit ◽

Transit Constipation

Patients with chronic constipation who do not respond to initial treatments often need further evaluation for dyssynergic defecation (DD) and slow transit constipation (STC). The aims of this study are to characterize the prevalence of DD and STC in patients referred to a motility center with chronic constipation and correlate diagnoses of DD and STC to patient demographics, medical history, and symptoms. High-resolution ARM (HR-ARM), balloon expulsion testing (BET) and whole gut transit scintigraphy (WGTS) of consecutive patients with chronic constipation were reviewed. Patients completed questionnaires describing their medical history and symptoms at the time of testing. A total of 230 patients completed HR-ARM, BET, and WGTS. Fifty (22%) patients had DD, and 127 (55%) patients had STC. Thirty patients (13%) had both DD and STC. There were no symptoms that were suggestive of STC vs. DD; however, patients with STC and DD reported more severe constipation than patients with normal transit and anorectal function. Patients with chronic constipation often need evaluation for both DD and STC to better understand their pathophysiology of symptoms and help direct treatment.

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Sa1662 – Characteristics of Patients Who ‘Fail’ Biofeedback Therapy for Dyssynergic Defecation: Discordance Between Patient Reported Outcomes, Stool Diary Findings and Objective Manometric Parameters

Gastroenterology ◽

10.1016/s0016-5085(19)37729-7 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-358

Author(s):

Samantha Spilman ◽

David C. Kunkel

Keyword(s):

Patient Reported Outcomes ◽

Biofeedback Therapy ◽

Dyssynergic Defecation ◽

Patient Reported

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Benefit of Pelvic Floor Physical Therapy in Pediatric Patients with Dyssynergic Defecation Constipation

Digestive Diseases ◽

10.1159/000500121 ◽

2019 ◽

Vol 37 (6) ◽

pp. 478-485 ◽

Cited By ~ 1

Author(s):

Claire Zar-Kessler ◽

Braden Kuo ◽

Elizabeth Cole ◽

Anna Benedix ◽

Jaime Belkind-Gerson

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Chronic Constipation ◽

Muscle Tone ◽

Colonic Surgery ◽

Tertiary Referral Center ◽

Dyssynergic Defecation ◽

Pelvic Floor Physical Therapy ◽

Novel Treatment ◽

Balloon Expulsion

Objectives: Chronic constipation is a common childhood problem and often caused or worsened by abnormal dynamics of defecation. The aim of this study was to assess the benefit of pelvic floor physical therapy (PFPT), a novel treatment in pediatrics for the treatment of chronic constipation with dyssynergic defecation. Methods: This was a retrospective study of 69 children seen at a pediatric neurogastroenterology program of a large tertiary referral center for chronic constipation and dyssynergic defecation, determined by anorectal manometry and balloon expulsion testing. We compared the clinical outcome of patients who underwent PFPT (n = 49) to control patients (n = 20) whom received only medical treatment (laxatives/stool softeners). Additionally, characteristics of the treatment group were analyzed in relation to therapeutic response. Results: Thirty-seven (76%) of the patients who received physical therapy had improvement in constipation symptoms, compared to 5 (25%) of the patients on conservative treatment (p < 0.01). Additionally, patients who received pelvic physical therapy had fewer hospitalizations for cleanouts (4 vs. 25%, p = 0.01) and colonic surgery than those that were treated with medical therapy exclusively (0 vs. 10%, p = 0.03). Among the patients who received physical therapy, those that suffered from anxiety and/or low muscle tone had a higher response rate (100%). There were no adverse effects from the intervention. Conclusion: The new field of pediatric PFPT is a safe and effective intervention for children with dyssynergic defecation causing or contributing to chronic constipation, particularly in children whose comorbidities include anxiety and low muscle tone.

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