Clinical–alimentary tractBiofeedback Is Superior to Laxatives for Normal Transit Constipation Due to Pelvic Floor Dyssynergia
Section snippets
Inclusion criteria
- 1
Severe constipation present for more than 12 months and unresponsive to standard medical treatment.
- 2
Fulfills Rome II4 criteria for chronic constipation, ie, 2 or more of 6 symptoms present for at least 12 weeks of the preceding 12 months: straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction/blockage, or manual maneuvers to facilitate defecation on more than one fourth of bowel movements, or less than 3 bowel movements per week.
- 3
Paradoxical
Comparability of Treatment Groups
The biofeedback and laxative-treated groups were similar in age (33.3 ± 1.5 vs 35.1 ± 1.4 years, respectively; mean ± standard error) and sex (3 males vs 2 males). All patients were of Italian descent.
Adherence
All patients completed 5 sessions of biofeedback training or medication counseling as prescribed. All laxative-treated patients reported during monthly telephone calls that they took at least 90% of the prescribed dose during the first 6 months, and all reported taking the prescribed 2 packets of
Efficacy Evaluation
This large randomized controlled study showed that biofeedback for pelvic floor relaxation during defecation is more effective than laxatives for the treatment of PFD-type constipation. The differences in outcome were robust (4-fold difference in the proportion reporting major improvement; see Figure 2), and improvements were sustained for 2 years without additional training.
Patients’ ratings of improvement were supported by changes in specific symptoms of constipation reported in diaries: as
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Supported by grants RO1 DK57048 and R24 DK67674.