Biofeedback for pelvic floor dysfunction in constipation

Abstract

Pelvic floor dyssynergia is one of the commonest subtypes of constipation, and the conventional treatment (dietary fibre and laxatives) is often unsatisfactory. Recently biofeedback training has been introduced as an alternative treatment. The authors review the evidence for this approach and conclude that, although controlled studies are few and open to criticism, about two thirds of patients with pelvic floor dyssynergia should benefit from biofeedback training

Fig 1

Anorectal manometric tracings of a normal subject (upper tracing) and a patient with pelvic floor dyssynergia (lower tracing) during straining at defecation (arrows). Note that the normal subject relaxes the anal sphincter, whereas the patient displays a paradoxical contraction of the sphincter

Fig 2

Representative defecographic sequence of a patient with pelvic floor dyssynergia, showing insufficient opening of the anal canal and of the anorectal angle, with most of the contrast medium retained after straining. The sequence shows resting (upper left), contracting (upper right), straining (lower left), and after straining (lower right)