EFFECTS OF BIOFEEDBACK THERAPY ON ANORECTAL FUNCTION IN OBSTRUCTIVE DEFECATION

Biofeedback therapy improves symptoms in patients with constipation an d obstructive defecation. Whether it also improves anorectal function is unclear. Our purpose was to investigate prospectively the effects o f biofeedback therapy on subjective and objective parameters of anorec tal function in 25 consecutive patients with obstructive defecation. B iofeedback therapy consisted of pelvic floor relaxation exercises (pha se I) and neuromuscular conditioning of rectal sensation and rectoanal coordination, with a solid state manometry system and simulated defec ation maneuvers (phase II). The number of sessions was customized for each patient. Clinical improvement was assessed from the changes in an orectal manometry, balloon (50 cc) expulsion test, and the symptom and stool diaries. The number of therapy sessions varied [mean (range) = 6 (2-10)]. After therapy, when straining as if to defecate, the percen tage anal relaxation, intrarectal pressure, and defecation index incre ased (P < 0.001). The balloon expulsion time, laxative consumption, an d straining effort decreased (P < 0.001). Before therapy, 16/25 (64%) patients had impaired rectal sensation, and after therapy this improve d (P < 0.001). After therapy, 15/25 (60%) patients reported greater th an or equal to 75% satisfaction with bowel habit and 8/25 (32%) report ed greater than or equal to 50% satisfaction (P < 0.001); 15/16 (94%) patients discontinued digital disimpaction. Biofeedback therapy not on ly improves subjective but also objective parameters of anorectal func tion in at least 76% of patients by rectifying the underlying pathophy siologic disturbance(s). Sensory conditioning and customizing the numb er of sessions may offer additional benefits.