Randomized Controlled Trial of Biofeedback, Sham Feedback, and Standard Therapy for Dyssynergic Defecation

Rao, Satish S.; Seaton, Kara; Miller, Megan; Brown, Kice; Nygaard, Ingrid; Stumbo, Phyllis J.; Zimmerman, B.; Schulze, Konrad

doi:10.1016/j.cgh.2006.12.023

Cited by 329 publications

(302 citation statements)

References 40 publications

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“…Biofeedback treatment is an effective option for patients with OD (5,6,23), as was also recently demonstrated by controlled trials (9,10,24), and the present study confirmed this. In fact, 94% of our patients undergoing this training had a successful response, al least in the short term; however, there is evidence of a sustained response of up to two years in up to 80% of patients (9).…”

Section: Discussionsupporting

confidence: 79%

“…In fact, 94% of our patients undergoing this training had a successful response, al least in the short term; however, there is evidence of a sustained response of up to two years in up to 80% of patients (9). The efficacy of biofeedback training for OD is influenced by the skills of the biofeedback therapist and the technique used for training (9,10). We feel that the good results we obtained were due to the treatment being administered by the same physician with a long-standing experience in such training, as shown in sexually abused women with anismus (25).…”

Section: Discussionmentioning

confidence: 99%

“…This probably reflects different population samples, with a prevalence of 7% in the general population (8). In many of these patients biofeedback treatment is very effective (9,10).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of sexual and physical abuse in patients with obstructed defecation: impact on biofeedback treatment

Solé¹,

Bolino²,

Lueso³

et al. 2009

Rev. esp. enferm. dig.

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Background: obstructed defecation is one of the most common subtypes of constipation, and it is frequently responsive to biofeedback treatment.Aims: since a history of sexual and physical abuse may be present in patients with obstructed defecation, we assessed the incidence of abuse history in patients with obstructed defecation referred to a general gastroenterology practice, and whether such a history may lead to a different outcome of biofeedback training in these patients.Patients and methods: one hundred and twenty-one patients (17 men, 104 women, age 53 ± 15 years) with obstructed defecation were studied by retrospective chart review. Their history of sexual, physical and psychological abuse was obtained by a standard interview, and biofeedback training was carried out by means of a three-balloon technique.Results: a history of sexual/physical or psychological abuse was present in 12.4% patients. Biofeedback training yielded a successful improvement of obstructed defecation in 93% patients without abuse and in 100% of patients with abuse; this difference was not statistically different (p = 0.53).Conclusions: the prevalence of sexual/physical or psychological abuse in a population of patients with obstructed defecation referred to a general gastroenterology practice is relatively low; such a history seems not to affect the outcome of biofeedback training in these patients.Key words: Abuse. Biofeedback. Constipation. Obstructed defecation. INTRODUCTIONChronic constipation is a frequent complaint in clinical practice, and affects 3 to 30% of the general population in Western countries, particularly women (1). However, recent studies have shown that similar figures are also present in other countries, such as Latin America (2).The pathophysiological basis of chronic idiopathic constipation may basically be reconducted to two main subtypes, slow-transit constipation (STC) and constipation due to obstructed defecation (OD) (3). The latter, after excluding anatomical or mechanical causes, may be often due to paradoxical contraction or failure to relax of the pelvic floor muscles during attempts to defecate, which impedes the outflow of feces (4,5).The prevalence of OD in different series varies between 25 and 70% (6,7). This probably reflects different population samples, with a prevalence of 7% in the general population (8). In many of these patients biofeedback treatment is very effective (9,10).Even though behavioral or psychological disturbances are frequently encountered in OD, it is still controversial whether these abnormalities are the cause or the consequence of this often disabling symptom (11).Physical and/or psychical abuse are described with relative frequency in some functional gastrointestinal disorders, particularly in patients with irritable bowel syndrome (IBS) (12,13); less data are available for constipated, non-IBS patients. Two recent studies reported that more than 32% of patients with OD had a history of physical and/or psychical abuse (14,15). However, no data on the treatment of such pa...

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Prevalence of sexual and physical abuse in patients with obstructed defecation: impact on biofeedback treatment

Solé¹,

Bolino²,

Lueso³

et al. 2009

Rev. esp. enferm. dig.

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“…This result was largely predictable since patients did not receive any therapeutic intervention (i.e. biofeedback therapy) prior to undergoing HRM testing [9] . We observed a low correlation regarding dyssynergic defecation patterns between the two testing modalities.…”

Section: Conflict Of Interestsmentioning

confidence: 94%

A Comparison of Standard Anorectal Manometry and High Resolution Manometry Patterns in Dyssynergic Patients

Soubra

Valestin

et al. 2014

Journal of Gastroenterology and Hepatology Research

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AIM:To compare dyssynergic sub type patterns between SARM and HRM. METHODS: Patients with dyssynergic defecation diagnosed by ARM that had maintained the same stool patterns and frequency were re-evaluated with HRM while on waiting list for biofeedback training. Anorectal resting and squeezing pressure on the bed and commode were analyzed and compared between the two modalities. Paired t-test was used to compare the pressures and sensations. RESULTS: 25 dyssynergic patients diagnosed with SARM (F=21, age 41±12.9) underwent HRM. Twenty four patients had dyssynergia on HRM (96%). Twelve (48%) had similar patterns on≥one position, and five (20%) had similar patterns in both positions. When comparing between HRM and SARM, the maximum resting pressure (70 vs 55.6 mmHg p<0.01), anal straining on bed (73 vs 46.4 mHg, p<0.01), rectal straining on commode (107.4 vs 71.8 mmHg, p<0.01) and anal straining pressures on commode (76.3 vs 48.9 mmHg, p<0.01) significantly deferred between the exams respectively.

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“…Most (about 70%) defecatory disorder was adequately relieved by biofeedback therapy [172][173][174][175][176][177][178][179] and this favorable effect lasted for 2 years or more, as observed in long-term follow-up data, 173,174,178,179 whereas only 8% of isolated STC cases were treated effectively. 180 Regardless of concomitant STC, combined type patients reached satisfactory outcomes. 172 Moreover, this concomitant slow transit can resolve in 65% of defecatory disorders.…”

mentioning

confidence: 99%

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Shin

Jung

Lee

et al. 2016

J Neurogastroenterol Motil

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The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

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Randomized Controlled Trial of Biofeedback, Sham Feedback, and Standard Therapy for Dyssynergic Defecation

Cited by 329 publications

References 40 publications

Prevalence of sexual and physical abuse in patients with obstructed defecation: impact on biofeedback treatment

Prevalence of sexual and physical abuse in patients with obstructed defecation: impact on biofeedback treatment

A Comparison of Standard Anorectal Manometry and High Resolution Manometry Patterns in Dyssynergic Patients

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

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