BIOFEEDBACK TRAINING IN TREATMENT OF CHILDHOOD CONSTIPATION - A RANDOMIZED CONTROLLED-STUDY

Background Because abnormal defaecation dynamics, which can be modifie d by biofeedback, are considered to be the underlying problem in const ipation, biofeedback training may be a useful treatment for constipati on. This treatment has mainly been studied in uncontrolled trials. We evaluated defaecation dynamics and clinical outcome in chronically con stipated children in a randomised study comparing conventional treatme nt and conventional treatment with biofeedback training. Methods Patie nts, 5 to 16 years old, were referred to the Academic Medical Center i n Amsterdam by general practitioners, school doctors, paediatricians, and psychiatrists. They had to fulfil at least two of four criteria fo r paediatric constipation and were included if they had been treated m edically for at least one month before randomisation. Patients had a m edical history, abdominal and rectal examination, and anorectal manome try at the start and end of the 6-week intervention period. The conven tional group received laxative treatment with additional dietary advic e, toilet training, and maintenance of a diary of bowel habits, The bi ofeedback group received the same conventional treatment acid addition ally five biofeedback training sessions. During the first 3 weeks, pat ients visited the outpatient clinic weekly; two subsequent visits were twice monthly. Findings 94 patients were randomised to conventional t reatment (CT) and 98 to conventional treatment with additional biofeed back training (CT+BF). Normal defaecation dynamics increased in the CT group from 41% to 52% (not significant) and in the CT+BF group from 3 8% to 86% (p=0.001). At 6 weeks, more patients in the CT+BF group show ed normal defaecation dynamics, compared to the CT group (p<0.001). Th is result was unaltered by controlling for baseline status in a logist ic regression model. At 1 year, successful treatment (defaecation freq uency greater than or equal to/week, soiling and/or encopresis <2/mont h, and no laxatives) was accomplished in 59% of the CT and 50% of the CT+BF group (p=0.24). The results were maintained after 11/2 years fol low-up. No association was found between achievement of normal defaeca tion dynamics and clinical outcome. Interpretation Additional biofeedb ack training compared to conventional therapy did not result in higher success rates in chronically constipated children. Furthermore, achie vement of normal defaecation dynamics was not associated with success: abnormal defaecation dynamics seem not to play a crucial role in the pathogenesis of childhood constipation, Intensive conventional laxativ e treatment should remain the first choice in chronically constipated children.