Original Contributions

Diseases of the Colon & Rectum

, Volume 35, Issue 6, pp 530-536

First online:

Anal sphincter biofeedback relaxation treatment for women with intractable constipation symptoms

  • Geoffrey K. TurnbullAffiliated withDepartment of Medicine, Camp Hill Medical Centre, Dalhousie University
  • , Paul G. RitvoAffiliated withDepartment of Psychology and Psychiatry, Camp Hill Medical Centre, Dalhousie University

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Some constipated women have difficulty relaxing the striated muscles of the anal sphincters, sometimes called anismus. This study was developed to provide a biofeedback-based relaxation treatment to teach these patients to relax the “voluntary” anal sphincter muscle in order to assess whether this treatment would be effective in reducing symptomatology. Seven constipated patients who were unresponsive to a high-fiber diet and required persistent laxative dosing to achieve regular bowel frequency were studied. A dual-therapy approach, in which patients were taught to relax the anal sphincter muscles via bio-feedback from a manometric anal sphincter probe, was used. Concurrently, patients were instructed in general biofeedback-relaxation techniques. All were treated as outpatients. Complete data were collected on five patients, one patient discontinued therapy, and one patient moved after treatment was completed. Stool frequency improved from a mean of 1.9 per week to a mean of 4.9 per week in six patients (P <0.05). In the five patients who completed the entire protocol, pain and bloating symptom levels were compared before and after treatment. Abdominal pain grade was reduced from 12.8 per week to a mean of 4.4 per week (P <0.05), and bloating was reduced from a mean of 14.3 per week to a mean of 6.0 per week (P <0.06). Follow-up of 2 to 4.5 years posttherapy showed continued improvement in bowel function and abdominal symptomatology. This treatment appears to be effective in improving stool frequency and in reducing the associated abdominal pain and bloating symptoms in constipated women with anismus.

Key words

Constipation Biofeedback therapy Relaxation therapy Abdominal pain