Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Mar 26;2014(3):CD008486.
doi: 10.1002/14651858.CD008486.pub2.

Biofeedback for treatment of chronic idiopathic constipation in adults

Sue Woodward  1 , Christine Norton, Pauline Chiarelli
Affiliations

Biofeedback for treatment of chronic idiopathic constipation in adults

Sue Woodward et al. Cochrane Database Syst Rev. .

Abstract

Background: Biofeedback therapy has been used to treat the symptoms of people with chronic constipation referred to specialist services within secondary and tertiary care settings. However, different methods of biofeedback are used within different centres and the magnitude of suggested benefits and comparable effectiveness of different methods of biofeedback has yet to be established.

Objectives: To determine the efficacy and safety of biofeedback for the treatment of chronic idiopathic (functional) constipation in adults.

Search methods: We searched the following databases from inception to 16 December 2013: CENTRAL, the Cochrane Complementary Medicine Field, the Cochrane IBD/FBD Review Group Specialized Register, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsychINFO. Hand searching of conference proceedings and the reference lists of relevant articles was also undertaken.

Selection criteria: All randomised trials evaluating biofeedback in adults with chronic idiopathic constipation were considered for inclusion.

Data collection and analysis: The primary outcome was global or clinical improvement as defined by the included studies. Secondary outcomes included quality of life, and adverse events as defined by the included studies. Where possible, we calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes and the mean difference (MD) and 95% CI for continuous outcomes. We assessed the methodological quality of included studies using the Cochrane risk of bias tool. The overall quality of the evidence supporting each outcome was assessed using the GRADE criteria.

Main results: Seventeen eligible studies were identified with a total of 931 participants. Most participants had chronic constipation and dyssynergic defecation. Sixteen of the trials were at high risk of bias for blinding. Attrition bias (4 trials) and other potential bias (5 trials) was also noted. Due to differences between study populations, the heterogeneity of the different samples and large range of different outcome measures, meta-analysis was not possible. Different effect sizes were reported ranging from 40 to 100% of patients who received biofeedback improving following the intervention. While electromyograph (EMG) biofeedback was the most commonly used, there is a lack of evidence as to whether any one method of biofeedback is more effective than any other method of biofeedback. We found low or very low quality evidence that biofeedback is superior to oral diazepam, sham biofeedback and laxatives. One study (n = 60) found EMG biofeedback to be superior to oral diazepam. Seventy per cent (21/30) of biofeedback patients had improved constipation at three month follow-up compared to 23% (7/30) of diazepam patients (RR 3.00, 95% CI 1.51 to 5.98). One study compared manometry biofeedback to sham biofeedback or standard therapy consisting of diet, exercise and laxatives. The mean number of complete spontaneous bowel movements (CSBM) per week at three months was 4.6 in the biofeedback group compared to 2.8 in the sham biofeedback group (MD 1.80, 95% CI 1.25 to 2.35; 52 patients). The mean number of CSBM per week at three months was 4.6 in the biofeedback group compared to 1.9 in the standard care group (MD 2.70, 95% CI 1.99 to 3.41; 49 patients). Another study (n = 109) compared EMG biofeedback to conventional treatment with laxatives and dietary and lifestyle advice. This study found that at both 6 and 12 months 80% (43/54) of biofeedback patients reported clinical improvement compared to 22% (12/55) laxative-treated patients (RR 3.65, 95% CI 2.17 to 6.13). Some surgical procedures (partial division of puborectalis and stapled transanal rectal resection (STARR)) were reported to be superior to biofeedback, although with a high risk of adverse events in the surgical groups (wound infection, faecal incontinence, pain, and bleeding that required further surgical intervention). Successful treatment, defined as a decrease in the obstructed defecation score of > 50% at one year was reported in 33% (3/39) of EMG biofeedback patients compared to 82% (44/54) of STARR patients (RR 0.41, 95% CI 0.26 to 0.65). For the other study the mean constipation score at one year was 16.1 in the balloon sensory biofeedback group compared to 10.5 in the partial division of puborectalis surgery group (MD 5.60, 95% CI 4.67 to 6.53; 40 patients). Another study (n = 60) found no significant difference in efficacy did not demonstrate the superiority of a surgical intervention (posterior myomectomy of internal anal sphincter and puborectalis) over biofeedback. Conflicting results were found regarding the comparative effectiveness of biofeedback and botulinum toxin-A. One small study (48 participants) suggested that botulinum toxin-A injection may have short term benefits over biofeedback, but the relative effects of treatments were uncertain at one year follow-up. No adverse events were reported for biofeedback, although this was not specifically reported in the majority of studies. The results of all of these studies need to be interpreted with caution as GRADE analyses rated the overall quality of the evidence for the primary outcomes (i.e. clinical or global improvement as defined by the studies) as low or very low due to high risk of bias (i.e. open label studies, self-selection bias, incomplete outcome data, and baseline imbalance) and imprecision (i.e. sparse data).

Authors' conclusions: Currently there is insufficient evidence to allow any firm conclusions regarding the efficacy and safety of biofeedback for the management of people with chronic constipation. We found low or very low quality evidence from single studies to support the effectiveness of biofeedback for the management of people with chronic constipation and dyssynergic defecation. However, the majority of trials are of poor methodological quality and subject to bias. Further well-designed randomised controlled trials with adequate sample sizes, validated outcome measures (especially patient reported outcome measures) and long-term follow-up are required to allow definitive conclusions to be drawn.

PubMed Disclaimer

Conflict of interest statement

Sue Woodward: SW and CN have designed and recently completed an unfunded RCT comparing biofeedback with reflexology for constipation (being prepared for publication).

Christine Norton: CN has been paid an honorarium by Genesis Lt (UK), who market biofeedback equipment, for speaking at an educational event. CN is partly employed by St Mark’s Hospital, Harrow UK, which provides treatment, including biofeedback, for patients with constipation.

Pauline Chiarelli: PC was part of a team of 15 Australian experts from various healthcare professions who developed the recently published 'Guidelines for the management of constipation and faecal impaction in older adults'. The development of these guidelines was instigated by Norgine Pty Ltd under the auspices of the Continence Foundation of Australia. PC was paid an honorarium for this work.

Figures

1
1
Figure 1: Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 EMG biofeedback versus balloon sensory biofeedback, Outcome 1 Number improved.
2.1
2.1. Analysis
Comparison 2 EMG biofeedback versus manometry biofeedback, Outcome 1 Number improved.
3.1
3.1. Analysis
Comparison 3 One method of biofeedback versus surgery, Outcome 1 Number improved.
3.2
3.2. Analysis
Comparison 3 One method of biofeedback versus surgery, Outcome 2 Constipation score.
4.1
4.1. Analysis
Comparison 4 One method of biofeedback versus Botulinum toxin‐A, Outcome 1 Number improved.
4.2
4.2. Analysis
Comparison 4 One method of biofeedback versus Botulinum toxin‐A, Outcome 2 Constipation score.
5.1
5.1. Analysis
Comparison 5 EMG biofeedback versus electrical stimulation, Outcome 1 Bowel satisfaction score.
6.1
6.1. Analysis
Comparison 6 EMG biofeedback versus diazepam, Outcome 1 Number improved.
7.1
7.1. Analysis
Comparison 7 EMG biofeedback versus STARR procedure, Outcome 1 Successful treatment.
7.2
7.2. Analysis
Comparison 7 EMG biofeedback versus STARR procedure, Outcome 2 Obstructed defecation score.
8.1
8.1. Analysis
Comparison 8 One method of biofeedback versus control muscle relaxation, Outcome 1 Constipation severity index.
8.2
8.2. Analysis
Comparison 8 One method of biofeedback versus control muscle relaxation, Outcome 2 IBS‐QOL.
9.1
9.1. Analysis
Comparison 9 EMG biofeedback versus laxative (movicol), Outcome 1 Major clinical improvement.
10.1
10.1. Analysis
Comparison 10 Manometry biofeedback versus sham, Outcome 1 CSBM.
11.1
11.1. Analysis
Comparison 11 Manometry biofeedback versus standard care, Outcome 1 CSBM.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Bleijenberg 1994 {published data only}
    1. Bleijenberg G, Kuijpers HC. Biofeedback treatment of constipation: a comparison of two methods. American Journal of Gastroenterology 1994;89(7):1021‐6. - PubMed
Chang 2003 {published data only}
    1. Chang HS, Myung SJ, Yang SK, Jung HY, Kim TH, Yoon IJ, et al. Effect of electrical stimulation in constipated patients with impaired rectal sensation. International Journal of Colorectal Disease 2003;18(5):433‐8. - PubMed
Chiarioni 2006 {published data only}
    1. Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006;130(3):657‐64. - PubMed
Farid 2009 {published data only}
    1. Farid M, Monem HA, Omar W, Nakeeb AE, Fikry A, Youssef T, et al. Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients. International Journal of Colorectal Disease 2009;24(1):115‐20. - PubMed
Faried 2010 {published data only}
    1. Faried M, Nakeeb A, Youssef M, Omar W, Monem HA. Comparative study between surgical and non‐surgical treatment of anismus in patients with symptoms of obstructed defecation: a prospective randomized study. Journal of Gastrointestinal Surgery 2010;14(8):1235‐43. - PubMed
Glia 1997 {published data only}
    1. Glia A, Gylin M, Gullberg K, Lindberg G. Biofeedback retraining in patients with functional constipation and paradoxical puborectalis contraction: comparison of anal manometry and sphincter electromyography for feedback. Diseases of the Colon and Rectum 1997;40(8):889‐95. - PubMed
Hart 2012 {published data only}
    1. Hart SL, Lee JW, Berian J, Patterson TR, Rosario A, Varma MG. A randomized controlled trial of anorectal biofeedback for constipation. International Journal of Colorectal Disease 2012;27(4):459‐66. - PubMed
Heymen 1999 {published data only}
    1. Heymen S, Wexner SD, Vickers D, Nogueras JJ, Weiss EG, Pikarsky AJ. Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Diseases of the Colon and Rectum 1999;42(11):1388‐93. - PubMed
Heymen 2007 {published data only}
    1. Heymen S, Scarlett Y, Jones K, Drossman D, Ringel Y, Whitehead WE. Randomized controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia‐type constipation. Gastroenterology 2005;128(4 Suppl 1):A266. - PubMed
    1. Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized controlled trial (RCT) shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia‐type constipation (PFD). American Journal of Gastroenterology 2005;100(9):S335. - PubMed
    1. Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia‐type constipation. Diseases of the Colon and Rectum 2007;50(4):428‐41. - PubMed
    1. Heymen S, Scarlett Y, Whitehead WE. Twelve‐month follow‐up of randomized controlled trial (RCT) comparing biofeedback to alternative treatments for patients with pelvic floor dyssynergia‐type constipation (PFD). Gastroenterology 2008;134(4 Suppl 1):A65‐6. - PubMed
Hu 2006 {published data only}
    1. Hu WH, Li JH, Chan AO, Wong NY, Wong SH, Hui WM. Biofeedback is an effective treatment for functional constipation: a randomized controlled study. Gastroenterology 2006;130(4 Suppl 2):A287.
Jung 2007 {published data only}
    1. Jung KW, Myung SJ, Byeon JS, Min HJ, Yoon IJ, Ko JE, et al. Combined therapy with electrical stimulation and biofeeback in pelvic floor dyssynergia. Neurogastroenterology and Motility 2007;19(Suppl S3):74.
    1. Jung KW, Myung SJ, Byeon JS, Min HJ, Yoon IJ, Ko JE, et al. Electrical stimulation therapy in pelvic floor dyssynergia: prospective, randomized study combined with biofeedback. Journal of Gastroenterology and Hepatology 2007;22(Suppl 2):A209.
Koutsomanis 1995 {published data only}
    1. Koutsomanis D, Lennard‐Jones JE, Roy AJ, Kamm MA. Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Gut 1995;37(1):95‐9. - PMC - PubMed
    1. Koutsomanis D, Lennard‐Jones JE, Roy AJ, Kamm MA. Controlled randomized trial of biofeedback versus muscle training alone for intractable constipation. Gut 1994;35(4 Suppl):A184. - PMC - PubMed
Lehur 2008 {published data only}
    1. Lehur PA, Stuto A, Fantoli M, Villani RD, Queralto M, Lazorthes F, et al. Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicentre, randomized, controlled trial. Diseases of the Colon and Rectum 2008;51(11):1611‐8. - PubMed
Pourmomeny 2010 {published data only}
    1. Pourmomeni A, Emami MH, Amooshahi M, Adibi P. Comparing biofeedback therapy and balloon defecation training in treatment of dyssynergic defecation. Journal of Isfahan Medical School 2010;28(105).
Rao 2007 {published data only}
    1. Rao SS, Kinkade KJ, Schulze KS, Nygaard II, Brown KE, Stumbo PE, et al. Biofeedback therapy (bt) for dyssynergic constipation ‐ randomized controlled trial. Gastroenterology 2005;128(4 Suppl 1):S1853.
    1. Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback and standard therapy for dyssynergic defecation. Clinical Gastroentereology and Hepatology 2007;5(3):331‐8. - PubMed
    1. Rao SS, Seaton K, Schulze KS, Brown K, Zimmerman B. Effects of biofeedback on psychologic profiles and quality of life in dyssynergic defecation (DD) ‐ a randomized controlled trial. Gastroenterology 2007;132(4 Suppl 2):A522.
    1. Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Long‐term efficacy of biodeefback therapy for dyssynergic defecation: randomized controlled trial. American Journal of Gastroenterology 2010;105(4):890‐6. - PMC - PubMed
Simon 2009 {published data only}
    1. Simon MA, Bueno AM. Behavioural treatment of the dyssynergic defecation in chronically constipated elderly patients: a randomized controlled trial. Applied Psychophysiology and Biofeedback 2009;34(4):273‐7. - PubMed
You 2001 {published data only}
    1. You YT, Wang JY, ChangChien CR, Chen JS, Hsu KC, Tang R, et al. The treatment of outlet obstruction constipation. Formosan Journal of Surgery 2001;34:3‐10.

References to studies excluded from this review

Battaglia 2004 {published data only}
    1. Battaglia E, Serra AM, Buonafede G, Dughera L, Chistolini F, Morelli A, et al. Long‐term study on the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and slow‐transit constipation. Diseases of the Colon and Rectum 2004;47(1):90‐5. - PubMed
Binnie 1992 {published data only}
    1. Binnie NR, Papachrysostomou M, Clare N, Smith AN. Solitary rectal ulcer: the place of biofeedback and surgery in the treatment of the syndrome. World Journal of Surgery 1992;16(5):836‐40. - PubMed
Chiarioni 2005 {published data only}
    1. Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 2005;129(1):86‐97. - PubMed
Chiarioni 2007 {published data only}
    1. Chiarioni G, Whitehead WE, Bassotti G. Randomized control of biofeedback. Clinical Gastroenterology and Hepatology 2007;5(9):1119. - PubMed
Chiarioni 2010 {published data only}
    1. Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE. Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology 2010;138(4):1321‐9. - PMC - PubMed
Chiotakakou‐Faliakou 1998 {published data only}
    1. Chiotakakou‐Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Biofeedback provides long‐term benefit for patients with intractable, slow and normal transit constipation. Gut 1998;42(4):517‐21. - PMC - PubMed
Dallianas 2000 {published data only}
    1. Dallianas A, Skandalis N, Rimikis MN, Koutsomanis D, Kardasi M, Archimandritis A. Pelvic floor study in patients with obstructive defecation: influence of biofeedback. Journal of Clinical Gastroenterology 2000;30(2):176‐80. - PubMed
Emmanuel 2001 {published data only}
    1. Emmanuel A, Kamm M. Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation. Gut 2001;49(2):214‐9. - PMC - PubMed
Enck 2009 {published data only}
    1. Enck P, Voort IR, Klosterhalfen S. Biofeedback therapy in fecal incontinence and constipation. Neurogastroenterology and Motility 2009;21(11):1133‐41. - PubMed
Ferrara 2001 {published data only}
    1. Ferrara A, Jesus S, Gallagher JT, Williamson PR, Larach SW, Pappas D, et al. Time‐related decay of the benefits of biofeedback therapy. Techniques in Coloproctology 2001;5(3):131‐5. - PubMed
Horton 2008 {published and unpublished data}
    1. Horton N. A randomized controlled trial of biofeedback versus laxatives for chronic idiopathic constipation in women. UK Clinical Trials Gateway 2008. [ISRCTN35017966]
Keck 1994 {published data only}
    1. Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME, Schoetz DJ, et al. Biofeedback training is useful in fecal incontinence but disappointing in constipation. Diseases of the Colon and Rectum 1994;37(12):1271‐6. - PubMed
Lin 2005 {published data only}
    1. Lin Z, Lin L, Zhang HJ, Wang MF. Social psychological and behaviour characteristics of patients with functional constipation and the follow‐up of the effects of biofeedback therapy [Chinese]. Chinese Journal of Clinical Rehabilitation 2005;9(28):67‐9.
NCT00564707 {published data only}
    1. NCT00564707. Comparison of biofeedback therapy and botulinum toxin type A injections for treatment of painful levator ani syndrome in women: a randomized, prospective trial. clinicaltrials.gov/ct2/show/NCT00564707 (accessed 22 January 2014).
Park 2003 {published data only}
    1. Park DH, Myung SJ, Yoon IJ, Kwon OR, Ko JE, Chang HS, et al. Clinical factors associated with response to biofeedback therapy for patients with chronic constipation [Korean]. Korean Journal of Gastroenterlogy 2003;42(4):289‐6. - PubMed
Patankar 1997 {published data only}
    1. Patankar SK, Ferrara A, Larach SW, Williamson PR, Perozo SE, Levy JR, et al. Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation. Diseases of the Colon and Rectum 1997;40(8):907‐11. - PubMed
Roy 2000 {published data only}
    1. Roy AJ, Emmanuel AV, Storrie JB, Bowers J, Kamm MA. Behavioural treatment (biofeedback) for constipation following hysterectomy. British Journal of Surgery 2000;87(1):100‐5. - PubMed
Siproudhis 1995 {published data only}
    1. Siproudhis L, Dautreme S, Ropert A, Briand H, Renet C, Beusnel C, et al. Anismus and biofeedback: who benefits?. European Journal of Gastroenterology and Hepatology 1995;7(6):547‐52. - PubMed
Wiesel 2001 {published data only}
    1. Wiesel PH, Dorta G, Cuypers P, Herranz M, Kreis ME, Schnegg JF, et al. Patient satisfaction after biofeedback for constipation and pelvic floor dyssynergia. Swiss Medical Weekly 2001;131(11‐12):152‐6. - PubMed
Yang 2004 {published data only}
    1. Yang LM, Lin JB, Zhao YL, Liang JL, Lin H, Zhong Z, et al. Effects of biofeedback training by EMG on patients with chronic functional constipation. World Chinese Journal of Digestology 2004;12(3):730‐3.

References to studies awaiting assessment

Singles 1990 {published data only}
    1. Singles JM. Evaluation of a biofeedback‐based behaviour modification program for the treatment of chronic constipation [Thesis]. Norfolk, VA, USA: Old Dominion University, 1990.

References to ongoing studies

NCT00982839 {published data only}
    1. NCT00982839. Rectal sensory training ‐ a randomized controlled study of two techniques. clinicaltrials.gov/ct2/show/NCT00982839 (accessed 22 January 2014).
NCT01672216 {published data only}
    1. NCT01672216. Multicentre randomized controlled trial to compare the outcome of conservative triple target treatment with EMG‐biofeedback in chronic constipation (3T‐CO). clinicaltrials.gov/ct2/show/NCT01672216 (accessed 22 January 2014).

Additional references

Azpiroz 2002
    1. Azpiroz F, Enck P, Whitehead WE. Anorectal functional testing: review of collective experience. American Journal of Gastroenterology 2002;97(20):232‐40. - PubMed
Bassotti 1997
    1. Bassotti G, Whitehead WE. Biofeedback, relaxation training and cognitive behaviour modification as treatments for lower functional gastrointestinal disorders. QJM 1997;90(8):545‐50. - PubMed
Bassotti 2004
    1. Bassotti G, Chistolini F, Sietchiping‐Nzepa F, Roberto G, Morelli A, Chiarioni G. Biofeedback for pelvic floor dysfunction in constipation. BMJ 2004;328(7436):393‐6. - PMC - PubMed
Bharucha 2010
    1. Bharucha AE, Wald AM. Anorectal disorders. American Journal of Gastroenterology 2010;105(4):786‐94. - PMC - PubMed
Brandt 2005
    1. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. American Journal of Gastroenterology 2005;100(Suppl 1):S5‐S21. - PubMed
Cheng 2003
    1. Cheng C, Chan AO, Hui WM, Lam SK. Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population‐based study. Alimentary Pharmacology and Therapeutics 2003;18(3):319‐26. - PubMed
Chiarelli 2008
    1. Chiarelli P. Systematic review: the management of constipation using physical therapies including biofeedback. Australian and New Zealand Continence Journal 2008;14(1):6‐13.
Chiarioni 2008
    1. Chiarioni G, Whitehead WE. The role of biofeedback in the treatment of gastrointestinal disorders. Gastroenterology and Hepatology 2008;5(7):371‐82. - PubMed
Chiotakaku‐Faliakou 1998
    1. Chiotakakou‐Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Biofeedback provides long term benefit for patients with intractable, slow and normal transit constipation. Gut 1998;42(4):517‐21. - PMC - PubMed
Chronic Constipation Task Force 2005
    1. American College of Gastroenterology Chronic Constipation Task Force. An evidence‐based approach to the management of chronic constipation in North America. American Journal of Gastroenterology 2005;100(Suppl 1):S1‐4. - PubMed
Coulter 2002
    1. Coulter ID, Favreau JT, Hardy ML, Morton SC, Roth EA, Shekelle P. Biofeedback interventions for gastrointestinal conditions: a systematic review. Alternative Therapies in Health and Medicine 2002;8(3):76‐83. - PubMed
Denis 1981
    1. Denis PB, Cayron G, Galmiche JP. Biofeedback; the light at the end of the tunnel? Maybe for constipation. Gastroenterology 1981;80(5 Pt 1):1089‐90. - PubMed
Denis 1996
    1. Denis P. Methodology of biofeedback. European Journal of Gastroenterology and Hepatology 1996;8(6):530‐3. - PubMed
Enck 1993
    1. Enck P. Biofeedback training in disordered defecation: a critical review. Digestive Diseases and Sciences 1993;38(11):1953‐60. - PubMed
Enck 1996
    1. Enck P, Schafer R. Biofeedback applications in gastroenterology. European Journal of Gastroenterology and Hepatology 1996;8(6):534‐9. - PubMed
Fleshman 1992
    1. Fleshman JW, Dreznik Z, Meyer K, Fry RD, Carney R, Kodner IJ. Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction. Diseases of the Colon and Rectum 1992;35(1):1‐7. - PubMed
Frank 1999
    1. Frank L, Kleinman L, Farup C, Taylor L, Miner P. Psychometric validation of a constipation symptom assessment questionnaire. Scandanavian Journal of Gastroenterology 1999;34(9):870‐7. - PubMed
Gilliland 1997
    1. Gilliland R, Heymen S, Altomare DF, Park UC, Vickers D, Wexner S. Outcome and predictors of success of biofeedback for constipation. British Journal of Surgery 1997;84(8):1123‐6. - PubMed
Guyatt 2008a
    1. Guyatt G, Rennie D, Meade MO, Cook DJ. User’s Guide to the Medical Literature: Essentials of Evidence Based Medicine. 2nd Edition. New York: JAMA Evidence, 2008.
Guyatt 2008b
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. - PMC - PubMed
Heymen 2003
    1. Heymen S, Jones KR, Scarlett Y, Whitehead WE. Biofeedback treatment for constipation: a critical review. Diseases of the Colon and Rectum 2003;46(9):1208‐17. - PubMed
Higgins 2004
    1. Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. American Journal of Gastroenterology 2004;99(4):750‐9. - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Irvine 2002
    1. Irvine EJ, Ferrazzi S, Pare P, Thompson WG, Rance L. Health‐related quality of life in functional GI disorders: focus on constipation and resource utilization. American Journal of Gastroenterology 2002;97(8):1986‐93. - PubMed
Jorge 2003
    1. Jorge JMN, Habr‐Gama A, Wexner SD. Biofeedback therapy in the colon and rectal practice. Applied Psychophysiology and Biofeedback 2003;28(1):47‐61. - PubMed
Koh 2008
    1. Koh CE, Young CJ, Young JM, Solomon MJ. Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. British Journal of Surgery 2008;95(9):1079‐87. - PubMed
Koutsomanis 1994
    1. Koutsomanis D, Lennard‐Jones JE, Kamm M. Prospective study of biofeedback treatment for patients with slow and normal transit constipation. European Journal of Gastroenterology and Hepatology 1994;6(2):131‐7.
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lestar 1991
    1. Lestàr B, Pennickx F, Kerremans R. Biofeedback defaecation training for anismus. International Journal of Colorectal Disease 1991;6(4):202‐7. - PubMed
Longstreth 2006
    1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006;130(5):1480‐91. - PubMed
Mason 2002
    1. Mason HJ, Serrano‐Ikkos E, Kamm MA. Psychological state and quality of life in patients having behavioural treatment (biofeedback) for intractable constipation. American Journal of Gastroenterology 2002;97(12):3154‐9. - PubMed
Moher 2001
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomised trials. Lancet 2001;357(9263):1191‐4. - PubMed
Norton 2012
    1. Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database of Systematic Reviews 2012, Issue 7. [DOI: 10.1002/14651858.CD002111.pub3] - DOI - PMC - PubMed
Palsson 2004
    1. Palsson OS, Heymen S, Whitehead WE. Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. Applied Psychophysiology and Biofeedback 2004;29(3):153‐74. - PubMed
Papachrysostomou 1994
    1. Papachrysostomou M, Smith AN. Effects of biofeedback on obstructive defecation‐‐reconditioning of the defecation reflex?. Gut 1994;35(2):252‐6. - PMC - PubMed
Rao 1997
    1. Rao SS, Welcher KD, Pelsang RE. Effects of biofeedback therapy on anorectal function in obstructive defecation. Digestive Diseases and Sciences 1997;42(11):2197‐205. - PubMed
Rao 1998
    1. Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. American Journal of Gastroenterology 1998;93(7):1042‐50. - PubMed
Rao 2008
    1. Rao SS. Dyssynergic defecation and biofeedback therapy. Gastroenterology Clinics of North America 2008;37(3):549‐86. - PMC - PubMed
Rao 2010
    1. Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Long‐term efficacy of biodeefback therapy for dyssynergic defecation: randomized controlled trial. American Journal of Gastroenterology 2010;105(4):890‐6. - PMC - PubMed
Rhee 2000
    1. Rhee PL, Choi MS, Kim YH, Son HJ, Kim JJ, Koh KC, et al. An increased rectal maximum tolerable volume and long anal canal are associated with poor short‐term response to biofeedback therapy for patients with anismus with decreased bowel frequency and normal colonic transit time. Diseases of the Colon and Rectum 2000;43(10):1405‐11. - PubMed
Rieger 1997
    1. Rieger NA, Wattchow DA, Sarre RG, Saccone GT, Rich CA, Cooper SJ, et al. Prospective study of biofeedback for treatment of constipation. Diseases of the Colon and Rectum 1997;40(10):1143‐8. - PubMed
Schiller 2001
    1. Schiller LR. Review article: the therapy of constipation. Alimentary Pharmacology and Therapeutics 2001;15(6):749‐63. - PubMed
Schünemann 2011
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Scott 2008
    1. Scott SM, Gladman MA. Manometric, sensorimotor, and neurophysiologic evaluation of anorectal function. Gastroenterology Clinics of North America 2008;37(3):511‐38. - PubMed
Shin 2010
    1. Shin JK, Cheon JH, Kim ES, Yoon JY, Lee JH, Jeon SM, et al. Predictive capability of anorectal physiologic tests for unfavourable outcomes following biofeedback therapy in dyssynergic defecation. Journal of the Korean Medical Science 2010;25(7):1060‐5. - PMC - PubMed
Simren 2001
    1. Simrén M, Abrahamsson H, Svedlund J, Björnsson ES. Quality of life in patients with irritable bowel syndrome seen in referral centres versus primary care: the impact of gender and predominant bowel pattern. Scandanavian Journal of Gastroenterology 2001;36(5):545‐52. - PubMed
Simren 2006
    1. Simrén M, Svedlund J, Posserud I, Björnsson ES, Abrahamsson H. Health‐related quality of life in patients attending a gastroenterology outpatient clinic: functional versus organic diseases. Clinical Gastroenterology and Hepatology 2006;4(2):187‐95. - PubMed
Thompson 1999
    1. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Mueller‐Lissner SA. Functional Bowel disorders and functional abdominal pain. Gut 1999;45(Suppl 11):1143‐7. - PMC - PubMed
Van Baal 1983
    1. Baal JG, Leguit P, Brummelkamp WH. Relaxation biofeedback conditioning as treatment of a disturbed defecation reflex: Report of a case. Diseases of the Colon and Rectum 1983;27(3):187‐9. - PubMed
Wexner 1992
    1. Wexner SD, Cheape JD, Jorge JMN, Heymen S, Jagelman DG. Prospective assessment of biofeedback for the treatment of paradoxical puborectalis contraction. Diseases of the Colon and Rectum 1992;35(2):145‐50. - PubMed
Whitehead 2010
    1. Whitehead WE, Bharucha AE. Diagnosis and treatment of pelvic floor disorders: what’s new and what to do. Gastroenterology 2010;138(4):1231‐5. - PMC - PubMed
Wong 2010
    1. Wong RK, Palsson OS, Turner MJ, Levy RL, Feld AD, Korff M, et al. Inability of the Rome III criteria to distinguish functional constipation from constipation‐subtype irritable bowel syndrome. American Journal of Gastroenterology 2010;105(10):2228‐34. - PMC - PubMed
Zhou 2008
    1. Zhou LK, Chang M, Ke MY. Systematic review of biofeedback for adult chronic constipation. Journal of Gastroenterology and Hepatology 2008;23(Suppl 5):A115.

Publication types

MeSH terms

LinkOut - more resources