Abdominal Symptoms Are Common and Benefit from Biofeedback Therapy in Patients with Dyssynergic Defecation

Abstract

Objectives:Dyssynergic defecation (DD) is a subtype of chronic constipation that responds to biofeedback therapy (BFT). Abdominal, anorectal, and stool symptoms are commonly reported by DD patients, but limited data exist to demonstrate the improvement of these associated symptoms to BFT. Aims to prospectively study the response of constipation and associated abdominal, rectal, and stool symptoms to biofeedback in a population with dyssynergia.Methods:Patients with DD as determined by anorectal manometry and balloon expulsion testing were included into the study. All patients completed a validated survey, the Personal Assessment of Constipation Symptom (PAC-SYM) questionnaire, before and following BFT. The PAC-SYM is a clinical tool to assess constipation-related symptom frequency and severity.Results:Seventy-seven dyssynergic patients fulfilled the study requirements. Abdominal symptoms were present in up to 74% of patients with dyssynergia. PAC-SYM summation scores improved following completion of biofeedback by 48%, from 22.08 to 11.48 (P<0.001). The proportion of patients with at least moderate symptoms decreased in all 12 questionnaire items, including all abdominal symptoms, after completing BFT (46.8% to 14.3%, P<0.001).Conclusions:Abdominal symptoms are common in patients with dyssynergia. BFT improves both anorectal-related constipation symptoms and associated abdominal symptoms in patients with DD. Limitations of this study are observational design, lack of control group, and lack of long-term follow-up.

A Narrative Review of Irritable Bowel Syndrome with Diarrhea: A Primer for Primary Care Providers

“…Dyssynergia is a defecatory disorder characterized by increased anal sphincter pressure (i.e., anal contraction; Table 1 ) for which biofeedback—using visual or auditory cues to improve muscle control—is efficacious [ 38 , 45 ]. It is important to ascertain whether the patient has intermittent constipation or solid stools, in which case, diarrhea may reflect an “overflow” phenomenon.…”

Pelvic Floor Physical Therapy and Women’s Health

“…Biofeedback is helpful in improving pelvic floor muscle strength in patients with low tone but is also used effectively in treatment of anismus or pelvic floor dyssynergia. A 2015 study showed a 48% improvement in patient symptom scores using the patient assessment of constipation-symptoms (PAC-SYM) questionnaire following 6-8 sessions of biofeedback therapy with manual and verbal biofeedback, surface electromyography (EMG), rectal balloon sensory therapy, pelvic floor and abdominal massage and core strengthening to correct dyssynergia [40].…”

Mistakes in chronic constipation treatment in adults

“…una maniobra defecatoria coordinada, contracción abdominal adecuada, relajación anal y mejorar la percepción rectal 8,9 . Existen estudios comparativos en los que la rehabilitación es superior a placebo, dieta, otras técnicas de biofeedback simulado, diazepam y laxantes consiguiendo unos resultados favorables en el 50-86% pacientes según los estudios y con una media 69%.…”