Biofeedback training in disordered defecation

A critical review


For 20 years now, biofeedback applications in the treatment of fecal incontinence and, more recently, chronic constipation in adults have proven that improvement of anorectal function can be achieved in a majority of patients. Despite this evidence, the definitive mode of action of biofeedback training remains obscure but may include improvement of both motor and sensory functions of the anorectum. In addition, behavioral modification of individual defecatory behavior in these patients may be effective as well. The long-term results of such treatment need to be tested in future research (64).

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  1. 1.

    Enck P, Koletzko S: Biofeedback therapy for defecation disorders in children—a review (in preparation)

  2. 2.

    Skinner BF: Science and Human Behavior. New York, Macmillan, 1953

    Google Scholar 

  3. 3.

    Miller NE: Learning of visceral and glandular responses. Science 163:434–445, 1969

    Google Scholar 

  4. 4.

    Miller NE: Effect of learning on gastrointestinal functions. Clin Gastroenterol 6:533–546, 1977

    Google Scholar 

  5. 5.

    Tarler-Benlolo L: The role of relaxation in biofeedback training: A critical review of the literature. Psychol Bull 85:272–255, 1978

    Google Scholar 

  6. 6.

    Steptoe A: Control of cardiovascular reactivity and the treatment of hypertension.In Behavioral Treatment of Disease. RS Surwit, RB Williams, A Steptoe, R Biersner (eds). New York, Plenum Press, 1982

    Google Scholar 

  7. 7.

    Olton DS, Noonberg AR: Biofeedback. Clinical Applications in Behavioral Medicine. Englewood Cliffs, New Jersey, Prentice Hall, 1980

    Google Scholar 

  8. 8.

    Sturgis ET, Adams HE: Use of cephalic vasomotor and electromyogram feedback in the treatment of migraine, muscle-contraction and combined headaches.In Biofeedback and Self-Regulation. N Birbaumer, HD Kimmel (eds). Hillsdale, New Jersey, L. Erlbaum 1988

    Google Scholar 

  9. 9.

    Brudny J, Korein J, Grynbaum BB, Friedman LW, Weinstein S, Sachs-Frankel G, Belandres PV: EMG-biofeedback therapy: A review. Arch Phys Med Rehabil 57:55–61, 1976

    Google Scholar 

  10. 10.

    Nikoomanesh P, Wells D, Schuster MM: Biofeedback control of lower esophageal sphincter contraction in man. Clin Res 21:521, 1973

    Google Scholar 

  11. 11.

    Whitehead WE, Drescher VM: Perception of gastric contractions and self-control of gastric motility. Psychophysiology 17:552–558, 1980

    Google Scholar 

  12. 12.

    Moore JG, Schenkenberg T: Psychic control of gastric acid: Response to anticipated feeding and biofeedback training in a man. Gastroenterology 66:954–959, 1974

    Google Scholar 

  13. 13.

    Welgan PR. Learned control of gastric acid secretion in ulcer patients. Psychosomat Med 36:411–419, 1974

    Google Scholar 

  14. 14.

    Whitehead WE, Schuster MM: Gastrointestinal Disorders. Behavioral and Physiological Basis for Treatment. New York, Academic Press, 1985

    Google Scholar 

  15. 15.

    Kröger C: Funktionelle Darmstörungen. Beschwerdebild und psychophysiologische Charakteristika des irritablen Kolons. Franfurt, P. Lang, 1986

    Google Scholar 

  16. 16.

    Kohlenberg JR: Operant conditioning of human anal sphincter pressure. J Appl Behav Anal 6:201–208, 1973

    Google Scholar 

  17. 17.

    Schiller LR, Santa Ana C, Davis GR, Fordtran JS: Fecal incontinence in chronic diarrhea. Report of a case with improvement after training with rectally infused saline. Gastroenterology 77:751–753, 1979

    Google Scholar 

  18. 18.

    MacLeod JH: Biofeedback in the management of partial anal incontinence—a preliminary report. Dis Colon Rectum 22:169–171, 1979

    Google Scholar 

  19. 19.

    MacLeod JH: Biofeedback in the management of partial anal incontinence. Dis Colon Rectum 26:244–246, 1983

    Google Scholar 

  20. 20.

    MacLeod JH: Management of anal continence by biofeedback. Gastroenterology 93:291–294, 1987

    Google Scholar 

  21. 21.

    Engel BT, Nikoomanesh P, Schuster MM: Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. N Engl J Med 290:646–649, 1974

    Google Scholar 

  22. 22.

    Cerulli MA, Nikoomanesh P, Schuster MM: Progress in biofeedback conditioning for fecal incontinence. Gastroenterology 76:742–746, 1979

    Google Scholar 

  23. 23.

    Goldenberg DA, Hodges K, Hersh T, Jinich H: Biofeedback therapy for fecal incontinence. Am J Gastroenterol 74:342–345, 1980

    Google Scholar 

  24. 24.

    Wald A: Biofeedback therapy for fecal incontinence. Ann Intern Med 95:146–149, 1981

    Google Scholar 

  25. 25.

    Wald A, Tunuguntla AK: Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. N Eng J Med 310:1282–1287, 1984

    Google Scholar 

  26. 26.

    Latimer PR, Campbell D, Kasperski J: A component analysis of biofeedback in the management of fecal incontinence. Biofeedback Self-Regul 9:311–324, 1984

    Google Scholar 

  27. 27.

    Whitehead WE, Burgio KL, Engel BT: Biofeedback treatment of fecal incontinence in geriatric patients. J Am Geriatr Soc 33:320–324, 1985

    Google Scholar 

  28. 28.

    Buser WD, Miner PB: Delayed rectal sensation with fecal incontinence. Successful treatment using anorectal manometry. Gastroenterology 91:1186–1191, 1986

    Google Scholar 

  29. 29.

    Riboli FB, Frascio M, Pitto G, Reboa G, Zanolla R: Biofeedback conditioning for fecal incontinence. Arch Phys Med Rehabil 69:29–31, 1988

    Google Scholar 

  30. 30.

    Enck P, Kränzle U, Schwiese J, Dietz M, Lübke MJ, Erckenbrecht JF, Wienbeck M, Strohmeyer G: Biofeedback-Behandlung bei Stuhlinkontinenz. Dtsch Med Wochenschr 113:1789–1794, 1988

    Google Scholar 

  31. 31.

    Loening-Baucke V: Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function. Gut 31:1395–1402, 1990

    Google Scholar 

  32. 32.

    Miner PB, Donelly TC, Read NW: Investigation of the mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 35:1291–1298, 1990

    Google Scholar 

  33. 33.

    Schuster MM, Hookman P, Hendrix T, et al.: Simultaneous manometric recording of internal and external anal sphincter reflexes. Bull John Hopkins Hosp 116:79–88, 1965

    Google Scholar 

  34. 34.

    Whitehead WE, Engel BT, Schuster MM: Perception of rectal distension is necessary to prevent fecal incontinence. Adv Physiol Sci 17:203–209, 1980

    Google Scholar 

  35. 35.

    Wald A: Biofeedback for neurogenic fecal incontinence: Rectal sensation is a determinant of outcome. J Pediatr Gastroenterol Nutr 2:302–306, 1983

    Google Scholar 

  36. 36.

    Whitehead WE, Parker L, Bosmaijan L, et al.: Treatment of fecal incontinence in children with spina bifida: Comparison of biofeedback and behavior modification. Arch Phys Med Rehabil 67:218–224, 1986

    Google Scholar 

  37. 37.

    Almy TP, Corson JA: Biofeedback—the light at the end of the tunnel? Gastroenterology 76:874–876, 1979

    Google Scholar 

  38. 38.

    Denis P, Crayon G, Galmiche JP: Biofeedback: The light at the end of the tunnel? Maybe for Constipation. Gastroenterology 80:23–24, 1980

    Google Scholar 

  39. 39.

    Buie LA, Butsch WL: The importance of recognizing contracting anus. Am J Dig Dis 5:162–164, 1938

    Google Scholar 

  40. 40.

    Wasserman IF: Puborectalis syndrome (rectal stenosis due to anorectal spasm). Dis Colon Rectum 7:87–98, 1964

    Google Scholar 

  41. 41.

    Martelli H, Devroede G, Arhan P, Duguay C: Mechanisms of idiopathic constipation: Outlet obstruction. Gastroenterology 75:623–631, 1978

    Google Scholar 

  42. 42.

    Turnbull GK, Lennard-Jones JE, Bartram CI: Failure of rectal expulsion as a cause of constipation: Why fibres and laxatives sometimes fail. The Lancet I:767–769, 1986

    Google Scholar 

  43. 43.

    Preston DM, Lennard-Jones JE: Anismus in chronic constipation. Dig Dis Sci 30:413–418, 1985

    Google Scholar 

  44. 44.

    Barnes PRH, Lennard-Jones JE: Balloon expulsion from the rectum in constipation of different types. Gut 26:1049–1052, 1985

    Google Scholar 

  45. 45.

    Wald A, Caruana BJ, Freimanis MG, Bauman DH, Hinds JP: Contributions of evacuation proctograpy and anorectal manometry to evaluation of adults with constipation and defecatory difficulties. Dig Dis Sci 35:481–487, 1990

    Google Scholar 

  46. 46.

    Watiers A, Devroede G, Duranceau A, Abdel-Rahman M, Duguay C, Forand MD, Tetreault L, Arhan P, Lamarche J, Elhilali M: Constipation with colonic inertia: A manifestation of systemic disease? Dig Dis Sci 28:1025–1033, 1983

    Google Scholar 

  47. 47.

    Kuijpers HC, Bleijenberg G: The spastic pelvic floor syndrome. Dis Colon Rectum 28:669–672, 1985

    Google Scholar 

  48. 48.

    Mathers SE, Kempster PA, Law PJ, Frankel JP, Bartram CI, Lees AJ, Stern GM, Swash M: Anal sphincter dysfunction in Parkinson's disease. Arch Neurol 46:1061–1064, 1989

    Google Scholar 

  49. 49.

    Bleijenberg G, Kuipers JHC: Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 30:108–111, 1987

    Google Scholar 

  50. 50.

    Weber J, Ducrotte P, Touchais JY, Roussignol RN, Denis P: Biofeedback training for constipation in adults and children. Dis Colon Rectum 30:844–846, 1987

    Google Scholar 

  51. 51.

    Dahl JA, Lindquist BL, Tysk C, Leissner P, Philipson L, Järnerot G: Behavioral medicine treatment in chronic constipation with paradoxical anal sphincter contraction. Dis Colon Rectum 34:769–776, 1991

    Google Scholar 

  52. 52.

    Kawimbe BM, Papachrysostomou M, Binnie NR, Clare N, Smith AN: Outlet obstruction constipation (animus) managed by biofeedback. Gut 32:1175–1179, 1991

    Google Scholar 

  53. 53.

    Lestar B, Penninckx F, Kerremans R: Biofeedback defaecation training for animus. Int J Colorect Dis 6:302–307, 1991

    Google Scholar 

  54. 54.

    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 35:1–7, 1992

    Google Scholar 

  55. 55.

    Wexner SD, Cheape JD, Jorge JMN, Heymen S, Jagelman DG: Prospective assessment of biofeedback for the treatment of paradoxical puborectalis contraction. Dis Colon Rectum 35:145–150, 1992

    Google Scholar 

  56. 56.

    Grimaud JC, Bouvier M, Naudy B, Guien C, Salducci J: Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal pain. Dis Colon Rectum 34:690–695, 1991

    Google Scholar 

  57. 57.

    Rovetto F: Treatment of chronic constipation by classical conditioning techniques. J Behav Ther Exp Psychiatry 10:143–146, 1979

    Google Scholar 

  58. 58.

    McCubbin JA, Survitt RS, Mansbach CM: Sensory discrimination training in the treatment of case of chronic constipation. Behav Ther 18:273–278, 1987

    Google Scholar 

  59. 59.

    Broden G, Dolk A, Frostell C, Nilsson B, Holmström B: Voluntary Relaxation of the external anal sphincter. Dis Colon Rectum 32:376–378, 1989

    Google Scholar 

  60. 60.

    Dolk A, Holmström B, Johansson C, Frostell C, Nilsson BY: The effect of yoga on puborectalis paradox. Int J Colorect Dis 6:139–142, 1991

    Google Scholar 

  61. 61.

    Anonymous. Anismus and biofeedback. Lancet 339:217–218, 1982

  62. 62.

    Enck P, Gantke B, Rühl A, Koletzko S, Zacchi P, Kalde S, Lübke HJ: What is a “spastic pelvic floor syndrome”? Gastroenterology 102:A446, 1992

    Google Scholar 

  63. 63.

    Rühl A, Gantke B, Enck P: Biofeedback training for faecal incontinence.In L Demling, P Frühmorgen (eds). Non-Neoplastic Diseases of the Anorectum. Dordrecht, Kluwer Academic, 1992, pp 37–44

    Google Scholar 

  64. 64.

    Enck P, Däublin G, Gantke B, Koletzko S, Lübke JH: Long-term effects of biofeedback therapy for incontinence. J Gastrointest Motil 4:218, 1992

    Google Scholar 

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Correspondence to Paul Enck PhD.

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Supported by a grant from the Deutsche Forschungsgemeinschaft, En 50/10.

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Enck, P. Biofeedback training in disordered defecation. Digest Dis Sci 38, 1953–1960 (1993).

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  • Public Health
  • Constipation
  • Fecal Incontinence
  • Sensory Function
  • Chronic Constipation