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A randomized controlled trial of anorectal biofeedback for constipation

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The purposes of this study were: (1) to examine the efficacy of anorectal biofeedback (AB) for constipation compared to a biofeedback control (BC) treatment and (2) to examine the extent to which self-reported childhood sexual/physical abuse predicted biofeedback outcome.

Methods

Twenty-one patients with pelvic floor dyssynergia were randomized to either (1) an AB arm, where patients learned to isolate the anal sphincter using an electromyography probe, or (2) a BC arm that controlled for the nonspecific effects of biofeedback, where patients learned to relax trapezius or temporalis muscles with EMG feedback. Both treatments were delivered by registered nurses for six sessions. Prior to randomization and post-treatment, patients completed the validated Constipation Severity Instrument and two measures of quality of life (QOL), the Irritable Bowel Syndrome-QOL, and the SF-36. Generalized estimating equations examined the within-group and between-group differences over time.

Results

Pre- and post-treatment data were obtained for six AB and nine BC patients. AB patients' overall constipation severity scores decreased by 35.5% (vs. 15.3%), and their obstructive defecation symptom scores decreased by 37.9% (vs. 19.7%) compared to BC. A similar pattern was shown on the IBS-QOL. On the SF-36 Mental Health Composite (MCS), AB scores improved 28.0% compared to BC scores, which worsened 12.7%. Those without (vs. with) a childhood sexual/physical abuse history showed improvement on the MCS post-biofeedback.

Conclusions

While our sample was statistically underpowered, AB produced clinical improvements in constipation severity and QOL.

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Acknowledgments

This clinical trial was registered at clinicaltrials.gov under NCT00502957. Support for this research comes from a Research Evaluation and Allocation Committee grant from the University of California, San Francisco, awarded to Dr. Varma. There are no financial relationships to disclose for any of the authors.

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Authors and Affiliations

  1. Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada

    Stacey L. Hart

  2. School of Medicine, Duke University, Durham, NC, USA

    Janet Waimin Lee

  3. School of Medicine, University of Chicago, Chicago, IL, USA

    Julia Berian

  4. Department of Psychology, North Carolina State University, Durham, NC, USA

    Taryn R. Patterson

  5. School of Medicine, University of Washington, Seattle, WA, USA

    Amanda del Rosario

  6. Section of Colorectal Surgery, University of California, San Francisco, San Francisco, CA, USA

    Madhulika G. Varma

Authors
  1. Stacey L. Hart
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  2. Janet Waimin Lee
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  3. Julia Berian
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  4. Taryn R. Patterson
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  5. Amanda del Rosario
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  6. Madhulika G. Varma
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Corresponding author

Correspondence to Stacey L. Hart.

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Hart, S.L., Lee, J.W., Berian, J. et al. A randomized controlled trial of anorectal biofeedback for constipation. Int J Colorectal Dis 27, 459–466 (2012). https://doi.org/10.1007/s00384-011-1355-9

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  • DOI: https://doi.org/10.1007/s00384-011-1355-9

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