Randomized, Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation
- 1 April 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 50 (4), 428-441
- https://doi.org/10.1007/s10350-006-0814-9
Abstract
This study was designed to determine whether biofeedback is more effective than diazepam or placebo in a randomized, controlled trial for patients with pelvic floor dyssynergia-type constipation, and whether instrumented biofeedback is necessary for successful training. A total of 117 patients participated in a four-week run-in (education and medical management). The 84 who remained constipated were randomized to biofeedback (n=30), diazepam (n=30), or placebo (n=24). All patients were trained to do pelvic floor muscle exercises to correct pelvic floor dyssynergia during six biweekly one-hour sessions, but only biofeedback patients received electromyography feedback. All other patients received pills one to two hours before attempting defecation. Diary data on cathartic use, straining, incomplete bowel movements, Bristol stool scores, and compliance with homework were reviewed biweekly. Before treatment, the groups did not differ on demographic (average age, 50 years; 85 percent females), physiologic or psychologic characteristics, severity of constipation, or expectation of benefit. Biofeedback was superior to diazepam by intention-to-treat analysis (70vs.23 percent reported adequate relief of constipation 3 months after treatment, chi-squared=13.1,P<0.001), and also superior to placebo (38 percent successful, chi-squared=5.7,P=0.017). Biofeedback patients had significantly more unassisted bowel movements at follow-up compared with placebo (P=0.005), with a trend favoring biofeedback over diazepam (P=0.067). Biofeedback patients reduced pelvic floor electromyography during straining significantly more than diazepam patients (P<0.001). This investigation provides definitive support for the efficacy of biofeedback for pelvic floor dyssynergia and shows that instrumented biofeedback is essential to successful treatment.Keywords
This publication has 29 references indexed in Scilit:
- Surgery and Constipation: When, How, Yes, or No?Journal of Pediatric Gastroenterology and Nutrition, 2005
- ADULTS WITH CHRONIC CONSTIPATION HAVE SIGNIFICANT HEALTH CARE RESOURCE UTILIZATION AND COSTS OF CAREAmerican Journal Of Gastroenterology, 2004
- Epidemiology of Constipation in North America: A Systematic ReviewAmerican Journal of Gastroenterology, 2004
- The impact of functional gastrointestinal disorders on quality of lifeThe American Journal of Gastroenterology, 2000
- Chronic constipation—Is the work-up worth the cost?Diseases of the Colon & Rectum, 1997
- Quality of Life in Patients with Different Types of Functional ConstipationScandinavian Journal of Gastroenterology, 1997
- Bowel Habit in Relation to Age and GenderArchives of Internal Medicine, 1996
- U. S. Householder survey of functional gastrointestinal disordersDigestive Diseases and Sciences, 1993
- Onset and Disappearance of Gastrointestinal Symptoms and Functional Gastrointestinal DisordersAmerican Journal of Epidemiology, 1992
- Anismus in chronic constipationDigestive Diseases and Sciences, 1985