Skip to main content

Advertisement

SpringerLink
Log in

A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults

  • Review
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Dyssynergic defaecation is a common form of functional constipation that responds poorly to conservative interventions. This systematic review and meta-analysis assesses the effectiveness of biofeedback therapy for dyssynergic defaecation using global clinical improvement as the primary outcome, and resolution of the dyssynergic pattern on anorectal physiology and quality of life as secondary outcomes.

Methods

MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Scopus, and Web of Science were searched from inception to March 2019 using a predefined strategy. Randomised controlled trials of adult patients with dyssynergic defaecation and a biofeedback treatment arm were eligible for review. Studies including patients with secondary forms of constipation were excluded. Data abstraction and risk of bias assessments were conducted by consensus between two authors.

Results

Eleven trials including 725 participants were included in the narrative review. Sixty-three percent of patients treated with biofeedback reported clinical improvement. Six studies included in the meta-analysis showed biofeedback superior to non-biofeedback therapy for the primary outcome (OR 3.63, CI 1.10–11.93, p = 0.03). Heterogeneity between trials and overall risk of bias was high.

Conclusions

Biofeedback therapy is recommended for patients referred to tertiary units with dyssynergic defaecation who fail conservative therapy. Future research should be directed towards identifying validated outcomes and the optimum method for delivering biofeedback therapy. Home biofeedback therapy may improve accessibility and recruitment to future clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Black CJ, Ford AC (2018) Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management. Med J Aust 209(2):86–91

  2. Suares NC, Ford AC (2011) Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol 106:1582

    Article  Google Scholar 

  3. Drossman DA (2016) Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. https://doi.org/10.1053/j.gastro.2016.02.032

  4. Rao SS, Tuteja AK, Vellema T, Kempf J, Stessman M (2004) Dyssynergic defecation: demographics, symptoms, stool patterns, and quality of life. J Clin Gastroenterol 38(8):680–685

    Article  Google Scholar 

  5. Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P (2014) Characteristics of functional bowel disorder patients: a cross-sectional survey using the Rome III criteria. Aliment Pharmacol Ther 39(3):312–321

    Article  CAS  Google Scholar 

  6. Vazquez Roque M, Bouras EP (2015) Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging 10:919–930

    PubMed  PubMed Central  Google Scholar 

  7. Rao SSC, Seaton K, Miller MJ, Schulze K, Brown CK, Paulson J et al (2007) Psychological profiles and quality of life differ between patients with dyssynergia and those with slow transit constipation. J Psychosom Res 63(4):441–449

    Article  Google Scholar 

  8. Wald A, Scarpignato C, Kamm MA, Mueller-Lissner S, Helfrich I, Schuijt C et al (2007) The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther 26(2):227–236

    Article  CAS  Google Scholar 

  9. Dennison C, Prasad M, Lloyd A, Bhattacharyya SK, Dhawan R, Coyne KJP (2005) The health-related quality of life and economic burden of constipation. Pharmacoeconomics 23(5):461–476

  10. Voderholzer WA, Schatke W, Muhldorfer BE, Klauser AG, Birkner B, Muller-Lissner SA (1997) Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol 92(1):95–98

    CAS  PubMed  Google Scholar 

  11. Muller-Lissner SA, Kamm MA, Scarpignato C, Wald A (2005) Myths and misconceptions about chronic constipation. Am J Gastroenterol 100(1):232–242

    Article  Google Scholar 

  12. Pinho M, Yoshioka K, Keighley MR (1989) Long term results of anorectal myectomy for chronic constipation. Br J Surg 76(11):1163–1164

    Article  CAS  Google Scholar 

  13. Barnes PR, Hawley PR, Preston DM, Lennard-Jones JE (1985) Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Br J Surg 72(6):475–477

    Article  CAS  Google Scholar 

  14. Maria G, Cadeddu F, Brandara F, Marniga G, Brisinda G (2006) Experience with type A botulinum toxin for treatment of outlet-type constipation. Am J Gastroenterol 101(11):2570–2575

    Article  Google Scholar 

  15. El-Tawil AM (2004) Reasons for creation of permanent ileostomy for the management of idiopathic chronic constipation. J Gastroenterol Hepatol 19(8):844–846

    Article  CAS  Google Scholar 

  16. Rao SSC, Benninga MA, Bharucha AE, Chiarioni G, Di Lorenzo C, Whitehead WE (2015) ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motility Off J Eur Gastrointest Motility Soc 27(5):594–609

    Article  CAS  Google Scholar 

  17. Koh CE, Young CJ, Young JM, Solomon MJ (2008) Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. Br J Surg 95(9):1079–1087

    Article  CAS  Google Scholar 

  18. Woodward S, Norton C, Chiarelli P (2014) Biofeedback for treatment of chronic idiopathic constipation in adults. Cochrane Datab Syst Rev. https://doi.org/10.1002/14651858.CD008486.pub2

  19. Enck P, Van Der Voort IR, Klosterhalfen S (2009) Biofeedback therapy in fecal incontinence and constipation. Neurogastroenterol Motil 21(11):1133–1141

  20. Chiarelli P (2008) Systematic review: the management of constipation using physical therapies including biofeedback. Aust N Zeal Continence J 14(1):6–13

    Google Scholar 

  21. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2019) Cochrane handbook for systematic reviews of interventions, version 6.0 (updated July 2019). Cochrane. Available from https://www.training.cochrane.org/handbook

  22. The Nordic Cochrane Centre, The Cochrane Collaboration (2014) Review manager (RevMan). Version 5.3. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen

  23. Aba-bai-ke-re M, Wen NR, Hu YL, Zhao L, Tuxun T, Husaiyin A et al (2014) Biofeedback-guided pelvic floor exercise therapy for obstructive defecation: an effective alternative. World J Gastroenterol 20(27):9162–9169

    Google Scholar 

  24. Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G (2006) Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 130(3):657–664

    Article  Google Scholar 

  25. Faried M, El Monem HA, Omar W, El Nakeeb A, Fikry A, Youssef T et al (2009) Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients. Int J Colorectal Dis 24(1):115–120

    Article  Google Scholar 

  26. Faried M, El Nakeeb A, Youssef M, Omar W, El Monem HA (2010) Comparative study between surgical and non-surgical treatment of anismus in patients with symptoms of obstructed defecation: a prospective randomized study. J Gastrointest Surg Off J Soc Surg Aliment Tract 14(8):1235–1243

    Article  Google Scholar 

  27. Gong BY, Ma HM, Zang XY, Wang SY, Zhang Y, Jiang N et al (2016) Efficacy of cranial electrotherapy stimulation combined with biofeedback therapy in patients with functional constipation. J Neurogastroenterol Motility 22(3):497–508

    Article  Google Scholar 

  28. Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE (2007) Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum 50(4):428–441

    Article  Google Scholar 

  29. Pourmomeny AA, Emami MH, Amooshahi M, Adibi P (2011) Comparing the efficacy of biofeedback and balloon-assisted training in the treatment of dyssynergic defecation. Can J Gastroenterol Journal canadien de gastroenterologie 25(2):89–92

    Article  Google Scholar 

  30. Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P et al (2007) Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 5(3):331–338

    Google Scholar 

  31. Rao SSC, Valestin JA, Xiang X, Hamdy S, Bradley CS, Zimmerman MB (2018) Home-based versus office-based biofeedback therapy for constipation with dyssynergic defecation: a randomised controlled trial. Lancet Gastroenterol Hepatol 3(11):768–777

    Article  Google Scholar 

  32. Simón MA, Bueno AM (2009) Behavioural treatment of the dyssynergic defecation in chronically constipated elderly patients: a randomized controlled trial. Appl Psychophysiol Biofeedback 34(4):273–277

    Article  Google Scholar 

  33. Simón MA, Bueno AM (2017) Efficacy of biofeedback therapy in the treatment of dyssynergic defecation in community-dwelling elderly women. J Clin Gastroenterol 51(10):e90–e94

    Article  Google Scholar 

  34. Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39(6):681–685

    Article  CAS  Google Scholar 

  35. Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K (2010) Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial. Am J Gastroenterol 105(4):890–896

    Article  Google Scholar 

Download references

Acknowledgements

This systematic review was not pre-registered with an institutional registry.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia

    D. Moore & C. J. Young

  2. Department of Surgery, The University of Sydney, Sydney, NSW, Australia

    C. J. Young

  3. RPAH Medical Centre, Suite G07/100 Carillon Ave, Newton, NSW, 2042, Australia

    C. J. Young

Authors
  1. D. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. J. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. J. Young.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest and no support from any organisation for the submitted work.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moore, D., Young, C.J. A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults. Tech Coloproctol 24, 909–918 (2020). https://doi.org/10.1007/s10151-020-02230-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-020-02230-9

Keywords

Search

Navigation