Skip to main content
Log in

Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

INTRODUCTION: Biofeedback training is an effective modality for the treatment of chronic constipation and fecal incontinence. In general, patients express satisfaction and perceive functional improvement following biofeedback therapy; however, quantifying these observations has been difficult. AIM: This study was undertaken to evaluate the physiologic benefits of biofeedback therapy as reflected by noninvasive electromyography parameters. METHODS: Fifty-five patients who underwent computerized electromyography-based biofeedback treatment at our institution between July 1993 and July 1995 were identified. Noninvasive electromyographic testing was performed before, during (weekly), and at completion of training. Mean number of weekly sessions was seven (range, 5–11). Short-term and ten-second contractions (amplitude/μV), sustained contractions (endurance, in seconds), and net strength (μV) of the external anal sphincter before and after biofeedback were compared for differences. RESULTS: There were 30 patients with chronic constipation, mean age, 65.3 (range, 33–86) years, composed of 24 women, and 25 patients with fecal incontinence, mean age 66 (range, 34–85) years, composed of 12 males. Statistically significant improvement in endurance and net strength following biofeedback training was noted in both the constipated and the fecal incontinence groups. Fifty-three of 55 (96.4 percent) patients expressed 50 to 100 percent subjective satisfaction after biofeedback therapy. Forty-six of 55 (83.6 percent) patients demonstrated individually improved endurance. CONCLUSIONS: Sphincter endurance and net strength, as measured by noninvasive electromyography, significantly improve following biofeedback therapy in both constipated and fecal incontinence patients. These data suggest that endurance and net strength may be useful tools in assessing a benefit from biofeedback training in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wexner SD, Cheape JD, Jorge JM, Heymen S, Jagelman DG. Prospective assessment of biofeedback for the treatment of paradoxical puborectalis contraction. Dis Colon Rectum 1992;35:145–50.

    Article  PubMed  CAS  Google Scholar 

  2. Bleijenberg G, Kuijpers HC. Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 1987;30:108–11.

    PubMed  CAS  Google Scholar 

  3. Kawimbe BM, Papachrysostomou M, Binnie NR, Clare N, Smith AN. Oulet obstruction constipation (anismus) managed by biofeedback. Gut 1991;32:1175–9.

    PubMed  CAS  Google Scholar 

  4. Turnbull GK, Ritvo PG. Anal sphincter biofeedback relaxation treatment for women with intractable constipation symptoms. Dis Colon Rectum 1992;35:530–6.

    Article  PubMed  CAS  Google Scholar 

  5. Fleshman JW, Dreznik Z, Meyer K, Fry RD, Carney R, Kodner IJ. Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction. Dis Colon Rectum 1992;35:1–7.

    PubMed  CAS  Google Scholar 

  6. Sangwan YP, Coller JA, Barrett RC, Roberts PL, Murray JJ, Schoetz DJ Jr. Can manometric parameters predict response to biofeedback therapy in fecal incontinence? Dis Colon Rectum 1995;38:1021–5.

    Article  PubMed  CAS  Google Scholar 

  7. Patankar SK, Ferrara A, Levy JR, Larach SW, Williamson PR, Perozo SE. Biofeedback in colorectal practice: a multicenter, statewide, 3-year experience. Dis Colon Rectum 1997;40:827–31.

    PubMed  CAS  Google Scholar 

  8. Perozo SE, Ferrara A, Patankar SK, Larach SW, Williamson PR. Biofeedback with home trainer program is effective for both incontinence and pelvic floor dysfunction. Tech Coloproctology 1997;5:6–9.

    Google Scholar 

  9. Loening-Baucke V. Biofeedback training in children with functional constipation—a critical review. Dig Dis Sci 1996;41:65–71.

    PubMed  CAS  Google Scholar 

  10. van der Plas RN, Benninga MA, Bηller HA,et al. Biofeedback training in treatment of childhood constipation: a randomised controlled study. Lancet 1996;348:776–80.

    Article  PubMed  Google Scholar 

  11. Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. N Engl J Med 1974;290:646–9.

    Article  PubMed  CAS  Google Scholar 

  12. Wald A. Biofeedback therapy for fecal incontinence. Ann Intern Med 1981;95:146–9.

    PubMed  CAS  Google Scholar 

  13. Enck P, Daublin G, Lubke HJ, Strohmeyer G. Long-term efficiency of biofeedback training for fecal incontinence. Dis Colon Rectum 1994;37:997–1001.

    Article  PubMed  CAS  Google Scholar 

  14. Guillemot F, Bouche B, Gower-Rousseau C,et al. Biofeedback for the treatment of fecal incontinence: long-term clinical results. Dis Colon Rectum 1995;38:393–7.

    PubMed  CAS  Google Scholar 

  15. Whitehead WE, Burgio KL, Engel BT. Biofeedback treatment of fecal incontinence in geriatric patients. J Am Geriatr Soc 1985;33:320–4.

    PubMed  CAS  Google Scholar 

  16. Miner PB, Donnelly TC, Read NW. Investigation of mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 1990;35:1291–8.

    Article  PubMed  CAS  Google Scholar 

  17. Wald A. Biofeedback for neurogenic fecal incontinence: rectal sensation is a determinant of outcome. J Pediatr Gastroenterol Nutr 1983;2:302–6.

    PubMed  CAS  Google Scholar 

  18. Cerrulli MA, Nikoomanesh P, Schuster MM. Progress in biofeedback conditioning for fecal incontinence. Gastroenterology 1979;76:742–6.

    PubMed  Google Scholar 

  19. Latimer PR, Campbell D, Kasperski J. A component analysis of biofeedback in the management of fecal incontinence. Biofeedback Self Regul 1984;9:311–24.

    Article  PubMed  CAS  Google Scholar 

  20. MacLeod JH, Management of anal incontinence by biofeedback. Gastroenterology 1987;93:291–4.

    PubMed  CAS  Google Scholar 

  21. Weber J, Ducrotte P, Touchais JY, Roussignol C, Denis P. Biofeedback training for constipation in adults and children. Dis Colon Rectum 1987;30:844–6.

    PubMed  CAS  Google Scholar 

  22. Wald A, Chandra R, Gabel S, Chiponis D. Evaluation of biofeedback in childhood encopresis. J Pediatr Gastroenterol Nutr 1987;6:554–8.

    Article  PubMed  CAS  Google Scholar 

  23. Keren S, Wagner Y, Heldenberg D, Golan M. Studies of manometric abnormalities of the rectoanal region during defecation in constipated and soiling children: modification through biofeedback therapy. Am J Gastroenterol 1988;83:827–31.

    PubMed  CAS  Google Scholar 

  24. Benninga MA, Büller HA, Taminiau JA. Biofeedback training in chronic constipation. Arch Dis Child 1993;68:126–9.

    Article  PubMed  CAS  Google Scholar 

  25. Papachrysostomou M, Smith AN. Effects of biofeedback on obstructive defecation-reconditioning of the defecation reflex? Gut 1994;35:252–6.

    PubMed  CAS  Google Scholar 

  26. Loening-Baucke V. Modulation of abnormal defecation dynamics by biofeedback treatment in chronically constipated children with encopresis. J Pediatr 1990;116:214–22.

    PubMed  CAS  Google Scholar 

  27. Bleijenberg G, Kuijpers HC. Biofeedback treatment of constipation: a comparison of two methods. Am J Gastroenterol 1994;89:1021–6.

    PubMed  CAS  Google Scholar 

  28. Bassotti G, Whitehead WE. Biofeedback as a treatment approach to gastrointestinal tract disorders. Am J Gastroenterol 1994;89:158–64.

    PubMed  CAS  Google Scholar 

  29. Park UC, Choi SK, Piccirillo MF, Verzaro R, Wexner SD. Patterns of anismus and the relation to biofeedback therapy. Dis Colon Rectum 1996;39:768–73.

    PubMed  CAS  Google Scholar 

  30. Ho Y-H, Tan M, Goh H-S. Clinical and physiologic effects of biofeedback in outlet obstruction constipation. Dis Colon Rectum 1996;39:520–4.

    Article  PubMed  CAS  Google Scholar 

  31. Hämäläinen K-PJ, Raivo P, Antila S, Palmu A, Mecklin J-P. Biofeedback therapy in rectal prolapse patients. Dis Colon Rectum 1996;39:262–5.

    PubMed  Google Scholar 

  32. Berti-Riboli E, Frascio M, Pitto G,et al. Biofeedback conditioning for fecal incontinence. Arch Phys Med Rehabil 1988;69:29–31.

    PubMed  CAS  Google Scholar 

  33. Whitehead WE, Parker LH, Bosmajian L,et al. Treatment of fecal incontinence in children with spina bifida: comparison of biofeedback and behavioral modification. Arch Phys Med Rehabil 1986;67:218–24.

    PubMed  CAS  Google Scholar 

  34. Loening-Baucke V, Desch L, Wolraich M. Biofeedback training for patients with myelomeningocoel and fecal incontinence. Dev Med Child Neurol 1988;30:781–90.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Patankar, S.K., Ferrara, A., Larach, S.W. et al. Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation. Dis Colon Rectum 40, 907–911 (1997). https://doi.org/10.1007/BF02051197

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02051197

Key words

Navigation