Current Treatment Options in Gastroenterology

, Volume 12, Issue 4, pp 456–467 | Cite as

Management of Pelvic Floor Disorders: Biofeedback and More

  • David Prichard
  • Adil E. BharuchaEmail author
Motility (T Lembo, Section Editor)

Opinion statement

Defecatory disorders (DD) and fecal incontinence (FI) are common conditions. DD are primarily attributable to impaired rectoanal function during defecation or structural defects. FI is caused by one or more disturbances of anorectal continence mechanisms. Altered stool consistency may be the primary cause or may unmask anorectal deficits in both conditions. Diagnosis and management requires a systematic approach beginning with a thorough clinical assessment. Symptoms do not reliably differentiate a DD from other causes of constipation such as slow or normal transit constipation. Therefore, all constipated patients who do not adequately respond to medical therapy should be considered for anorectal testing to identify a DD. Preferably, two tests indicating impaired defecation are required to diagnose a DD. Patients with DD, or those for whom testing is not available and the clinical suspicion is high, should be referred for biofeedback-based pelvic floor physical therapy. Patients with FI should be managed with lifestyle modifications, pharmacotherapy for bowel disturbances, and management of local anorectal problems (e.g., hemorrhoids). When these measures are not beneficial, anorectal testing and pelvic floor retraining with biofeedback therapy should be considered. Sacral nerve stimulation or perianal bulking could be considered in patients who have persistent symptoms despite optimal management of bowel disturbances and pelvic floor retraining.


Constipation Fecal incontinence Manometry Balloon expulsion test Defecography Biofeedback Botulinum toxin Sacral nerve stimulation Posterior tibial nerve stimulation STARR Peri-anal injectable bulking agents 


Compliance with Ethics Guidelines

Conflict of Interest

David Prichard declares that he has no conflict of interest.

Adil E. Bharucha has received consultancy fees from Medspira and Gicare Pharma. Dr. Bharucha has also received royalty payments from and has a patent with Medspira (ARM device).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC 2014

Authors and Affiliations

  1. 1.Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

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