RESULTS OF BIOFEEDBACK IN CONSTIPATED PATIENTS - A PROSPECTIVE-STUDY

PURPOSE: The aims of this study were to assess the results of biofeedb ack treatment in constipated patients and to identify variables that m ight be used to predict the outcome. METHOD: Twenty-eight patients (5 men; median age, 46 (range, 22-72) years) with any degree of paradoxic al activation measured with thin hook needle electromyography in the e xternal sphincter or puborectalis muscle were included. The symptom du ration varied between I and 30 (median, 9) years. The patients had eig ht outpatient training sessions with electromyography-based audiovisua l feedback. All patients were followed up prospectively with a validat ed bowel function questionnaire from which a symptom index was created . RESULTS: At three months, nine patients had no improvement and under went other treatments. The remaining 19 patients were followed up for a median of 14 (range, 12-34) months. Twelve patients (43 percent) sta ted they had improved rectal emptying. A good result was associated wi th increased stool frequency (P < 0.05), improved symptom index (P < 0 .01), and reduction of laxative use (P < 0.05). A long symptom duratio n, a high pretreatment symptom index, and laxative use were related to a poor result (P < 0.01-0.05). The improved group had less perineal d escent (P < 0.05), and a prominent puborectalis impression on defecogr aphy tended to be more common (P = 0.06). CONCLUSION: With the use of wide inclusion criteria, biofeedback was successful in 43 percent of p atients, with a treatment effect lasting at least one year. The result s suggest that biofeedback should be used as the initial treatment of constipated patients with a paradoxical puborectalis contraction.