PROSPECTIVE-STUDY OF BIOFEEDBACK TREATMENT FOR PATIENTS WITH SLOW ANDNORMAL TRANSIT CONSTIPATION

Objective: To assess biofeedback training as treatment in a consecutiv e series of patients with idiopathic constipation. Design: Symptomatic and physiological assessment before and after treatment. Methods: Ass essment included a record of symptoms by diary card, measurement of wh ole gut transit time, defecation proctography and anorectal function t ests. During training sessions, muscular activity of the pelvic floor was displayed to the patient as an electromyographic trace. The patien t was taught to recognize resting electrical activity and the increase associated with voluntary contraction of the pelvic floor. If there w as an increase (rather than the normal decrease) in activity during de fecation straining, the patient was encouraged to strain while maintai ning 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 rel ax the pelvic floor on defecation straining and an inability to strain effectively, both types improved with training. Of the 20 out of 30 u nselected patients who completed training, there was significant impro vement in bowel frequency, and a decrease in the number and duration o f straining episodes at every follow-up period. Patients recorded sign ificant overall perception of symptoms at each period; abdominal pain and bloating improved at 6 weeks and 6-12 months. Conclusion: Approxim ately 50% of the consecutive series of patients with constipation were helped by two to six biofeedback training sessions. The improvement p ersisted for at least 6-12 months.