Chiarioni G et al. (2005) Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 129: 86–97

Previous studies have suggested that using biofeedback to train pelvic floor muscle relaxation is effective in the treatment of slow-transit constipation and PELVIC FLOOR DYSSYNERGIA. Chiarioni and colleagues investigated the efficacy of biofeedback treatment in patients with slow-transit constipation, pelvic floor dyssynergia, or symptoms of both disorders.

In total, 52 patients were eligible for inclusion in the study (49 women and 3 men). Using anorectal manometry and balloon defecation tests, patients were classified as having slow-transit constipation only (STO), pelvic floor dyssynergia with slow transit (PFD), or as being mixed (slow-transit constipation plus one of the two criteria for PFD). A three-phase biofeedback training approach was then implemented in 5-weekly sessions of 30–45 min duration. Patients were trained to strain more effectively and, by means of an electromyographic anal plug, to relax the anal sphincter during straining. Lastly, defecation was practiced with an air-filled balloon.

On follow-up, the level of treatment satisfaction was significantly higher in patients with PFD than in those with STO, with 71% rating their satisfaction as fair or major in the PFD group compared with only 8% in the STO group. Greater symptom improvements in terms of stool frequency, straining, bloating and use of laxatives, as well as greater transit-time improvements, were also observed in PFD patients than in STO patients.

Chiarioni and colleagues conclude that this method of biofeedback is effective in the treatment of PFD but that, in contrast with previous reports, it is not suitable for STO.