Biofeedback therapy (bt) for dyssynergic constipation - randomized controlled trial.

Uncontrolled studies had suggested that BT may help patients with dyssynergia. Our aim was to perform a randomized controlled trial comparing BT (manometric-assisted pelvic relaxation, coordination and simulated defection training), with either sham feedback (relaxation therapy; RT) or standard therapy (diet, exercise, laxatives: ST) in patients with dyssynergic defecation. Stool diaries, visual analogue scales (VAS), colon transit study, anorectal manometry and balloon expulsion test were performed before and after therapy. RESULTS: (mean ± SEM): We randomized 77 subjects (69 women, mean age 43 years, mean duration 17 years); 21 completed BT,21 completed RT and 23 completed ST and 12 (16%) dropped out. Subjects in the BT group were more likely to normalize the dyssynergic pattern, improve the defecation index and balloon expulsion time and decrease colonic marker retention (table). The responder rate (>20%VAS change) for global satisfaction and stool frequency were higher for BT group compared to RT. CONCLUSIONS: BT effectively improves subjective and objective characteristics of bowel function in patients with dyssynergia. This effect is mediated by modifying physiologic behavior as it was not seen with RT despite similar degree of attention and coping strategies. Thus, BT should be the preferred treatment for patients with dyssynergia, especially for those who fail ST.