CLINICAL AND PHYSIOLOGICAL-EFFECTS OF BIOFEEDBACK IN OUTLET OBSTRUCTION CONSTIPATION

PURPOSE: We report the results of biofeedback (BF) on patients with ou tlet obstruction defecation (OOC), including those with and without me asurable paradoxical puborectalis contractions (PP). Clinical and anor ectal physiologic parameters (ARP) were assessed one week before and a fter a standardized course of BF. METHODS: Sixty-two consecutive patie nts (24 men, 38 women; mean age, 48 (standard error of the mean, 2.3) years) were recruited. All had persistent constipation despite six wee ks of dietary fiber supplements. Colonic inertia was excluded by trans it marker studies. Defecating proctography excluded anatomic abnormali ties causing outlet obstruction. Patients underwent four outpatient se ssions of biofeedback, each session lasting one hour. RESULTS: After B F, 56 patients (90.3 percent) were subjectively improved. Frequency of spontaneous bowel movements were significantly increased (P = 0.003). Frequency of laxative-induced (P = 0.004) and enema-induced (P = 0.00 5) stools were reduced. Anal resting (P = 0.04) and squeeze (P = 0.002 ) pressures were increased. Number of patients with PP was reduced fro m 40 to 31 (P = 0.004). Presence of PP did not affect response to BF. There were no differences in ARP between the 56 patients who improved and the 6 who did not. There mere no side effects or clinical regressi ons after a mean follow-up of 14.9 (standard error of the means, 0.9) months. CONCLUSIONS: BF effectively treated OOC in 90.3 percent, regar dless of PP. Anal pressures were increased, and PP was decreased.