Effects of biofeedback on psychologic profiles and quality of life in dyssynergic defecation (DD) - a randomized controlled trial.

INTRODUCTION: patients with dyssynergia also exhibit profound psychological dysfunction and impaired QOL (Gastroenterology 2005: 128: A783). Whether short term treatment (3 months) with biofeedback (BT) improvers these dysfunctions is unknown. METHODS: Patiens with DD (Rome II) enrolled in a RCT of 3 treatments were assessed at baseline and at end of treatment (3 months) with SCL-90-R and SF-36 questionnaires. BT consisted of six sessions of manometric-assisted pelvic floor relaxation; relaxation therapy (RT) consisted of 6 sessions of progressive muscle relaxation and standard therapy (ST) consisted of diet and laxatives. Clinical improvement was assessed by number of complete spontaneous bowel movements (CSBM) and presence of dyssynergia. Results: 65 patients (89%women) completed treatment. Psychological profiles were unaffected by BT, but 4 domains improved with RT and 2 with ST (table). There QOL domains improved with RT and one with BT but other domains were unaffected. An ITT analysis showed that the number of CSBM increased with BT when compared to baseline (p<0.02) or other treatments (p<0.05), but not with RT or ST. Likewise, dyssynergia normalized in 81% of BT group (p<0.0001) but not in other groups. CONCLUSIONS: Although biofeedback improved symptoms and anorectal function, it did not affect psychological profiles or QOL. In contrast, RT improved some of the psychological domains and QOL, possibly through its effect on stress reduction, although constipations did not improve. Alterations in psychological behavior and QOL appear to be independent of bowel dysfunction. Treatment of these dysfunctions may play an adjunct role in the management of DD.