Applied Psychophysiology and Biofeedback

, Volume 29, Issue 3, pp 153–174

Biofeedback Treatment for Functional Anorectal Disorders: A Comprehensive Efficacy Review

  • Olafur S. Palsson
  • Steve Heymen
  • William E. Whitehead
Article

Abstract

This review aimed to critically evaluate the literature on the efficacy of biofeedback for functional anorectal disorders, rate these biofeedback applications according to established guidelines, and make recommendations for this field based on the literature. The Medline and PsychInfo databases were searched to obtain all papers published from 1975 to 2003 that included the terms “biofeedback” and either “constipation,” “pelvic floor dyssynergia,” “fecal incontinence,” or “anorectal pain.” Adult and pediatric papers in any language were screened. Prospective studies with five or more participants and a description of the treatment protocol and outcome were selected for review. Seventy-four studies qualified for review: 33 trials on fecal incontinence (FI), 38 on pelvic floor dyssynergia (PFD) or functional constipation, and 3 on anorectal pain. Only 20% of studies were controlled outcome trials. Treatment protocols, etiological subgroups studied and outcome measures varied greatly. The overall average probability of successful treatment outcome for patients treated with biofeedback was 67.2% for functional FI and 62.4% for constipation. There were insufficient data to warrant such calculation for anorectal pain. According to standard efficacy rating criteria, biofeedback treatment is efficacious for functional constipation or PFD in children and probably efficacious in adults; probably efficacious for functional FI; and possibly efficacious for anorectal pain. Utilizing data from all applicable studies, we found that success rate per subject is significantly higher for biofeedback treatment than for standard medical care for PFD/functional constipation, and FI (p < .001 for both). Biofeedback treatment may therefore be viewed as a valuable adjunct to medical management of functional PFD/constipation and incontinence. A number of recommendations for future investigations are made based on the review.

biofeedback fecal incontinence constipation anorectal pain electromyography manometry pelvic floor visceral sensation 

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REFERENCES

  1. Arhan, P., Faverdin, C., Devroede, G., Besancon-Lecointe, I., Fekete, C., Goupil, G., (1994). Biofeedback re-education of faecal continence in children. International Journal of Colorectal Disease, 9 ,128–133.CrossRefPubMedGoogle Scholar
  2. Bellman, M. M. (1966). Studies on encopresis. Acta Paediatrica Scandinavica, 56(Suppl. 170), 1–151.Google Scholar
  3. Benninga, M. A., Buller, H. A., & Taminiau, J. A. (1993). Biofeedback training in chronic constipation. Archives of Disease in Childhood, 68 ,126–129.PubMedGoogle Scholar
  4. Bleijenberg, G., & Kuijpers, H. C. (1987). Treatment of the spastic pelvic floor syndrome with biofeedback. Diseases of the Colon and Rectum, 30 ,108–111.PubMedGoogle Scholar
  5. Bleijenberg, G., & Kuijpers, H. C. (1994). Biofeedback treatment of constipation: A comparison of two methods. American Journal of Gastroenterology, 89 ,1021–1206.PubMedGoogle Scholar
  6. Burnett, C., Whitehead, W. E., & Drossman, D. (1998). Psychological distress and impaired quality of life in patients with functional anorectal disorders [Abstract]. Gastroenterology, 114 ,A729.Google Scholar
  7. Buser, W. E., & Miner P. B. (1986). Delayed rectal sensation with fecal incontinence. Gastroenterology, 91 ,1186–1191.PubMedGoogle Scholar
  8. Cerulli, M., Nikoomanesh, P., & Schuster, M. M. (1979) Progress in biofeedback conditioning for fecal incontinence. Gastroenterology, 76 ,742–746.PubMedGoogle Scholar
  9. Chiarioni, G., Scattolini, C., Bonafante, F., & Vantini. I. (1993). Liquid stool incontinence with severe urgency: Anorectal function and effective biofeedback treatment. Gut, 34 ,1576–1580.PubMedGoogle Scholar
  10. Cox, D. J., Sutphen, J., Borowitz, S., Dickens, M. N., Singles, J., & Whitehead, W. E. (1994). Simple electromyographic biofeedback treatment for chronic pediatric constipation/encopresis: Preliminary Report. Biofeedback and Self-Regulation, 19 ,41–50.PubMedGoogle Scholar
  11. Dahl, J., Lindquist, B. L., Tysk, C., Leissner, P., Philipson, L.,& Jarnerot, G. (1991). Behavioral medicine treatment in chronic constipation with paradoxical anal sphincter contraction. Diseases of the Colon and Rectum, 34(9), 769–776.PubMedGoogle Scholar
  12. Dailianas, A., Skandalis, N., Rimikis, M. N., Koutsomanis, D., Kardasi, M., & Archimandritis, A. (2000). Pelvic floor study in patients with obstructed defecation: Influence of biofeedback. Journal of Clinical Gastroenterology, 30(2), 176–180.CrossRefPubMedGoogle Scholar
  13. Dey, A. N. (1997). Characteristics of elderly nursing home residents: Data from the 1995 National Nursing Home Survey. Advance data from vital and health statistics, No. 289. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  14. Drossman, D. A., Li, Z., Andruzzi, E., Temple, R. D., Talley, N. J., Thompson, W. G., et al. (1993). U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Digestive Diseases and Sciences, 38(9), 1569–1580.PubMedGoogle Scholar
  15. Emery, Y., Descos, L., Meunier, P., Louis, D., Valancogne, G., & Weil, G. (1980). Terminal constipation with abdominopelvic asynchronism: Analysis of etiological, clinical and manometric findings, and the results of biofeedback therapy. Gastroenterologie Clinique et Biologique, 12 ,6–11.Google Scholar
  16. Enck, P., Daublin, G., Lubke, H. J., & Strohmeyer, G. (1994). Long-term efficacy of biofeedback training for fecal incontinence. Diseases of the Colon and Rectum, 37(10), 997–1001.PubMedGoogle Scholar
  17. Engel, B. T., Nikoomanesh, P., & Schuster, M. M. (1974). Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. New England Journal of Medicine, 290 ,646–649.PubMedGoogle Scholar
  18. Faure, N., Ferriere, S., Maurauge, C., & Rolland, J. C. (1995). Biofeedback treatment in chronically constipated children. Archives de Pediatrie, 2 ,1055–1059.CrossRefPubMedGoogle Scholar
  19. Fleshman, J. W., Dreznik, Z., Meyer, K., Fry, R. D., Carney, R., & Kodner, I. J. (1992). Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction. Diseases of the Colon and Rectum, 35 ,1–7.PubMedGoogle Scholar
  20. Fox, J. Sylvestre, L.,& Freeman, J. B. (1991). Rectal incontinence: A team approach. Physiotherapy, 77 ,665–672.Google Scholar
  21. Ger, G. C., Wexner, S. D., Jorge, J. M., Lee, E., Amaranath, L. A., Heymen, S., et al. (1993). Evaluation and treatment of chronic intractable rectal pain-A frustrating endeavor. Diseases of the Colon and Rectum, 36(2), 139–145.PubMedGoogle Scholar
  22. Glia, A., Glyin, M., Gullberg, K.,& Lindberg, G. (1997). Biofeedback retraining in patients with functional constipation paradoxical puborectalis contraction. Comparison of anal manometry and sphincter electromyography for feedback. Diseases of the Colon and Rectum, 40 ,889–895.PubMedGoogle Scholar
  23. Gilliland, R., Heymen, S., Altomare, D. F., Park, U. C., Vickers, D., & Wexner, S. D. (1997). Outcome and predictors of success of biofeedback for constipation. The British Journal of Surgery, 84 ,1123–1126.CrossRefPubMedGoogle Scholar
  24. Grimaud, J. C., Bouvier, M., Naudy, B., Guien, C.,& Salducci, J. (1991). Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal pain. Diseases of the Colon and Rectum, 34(8), 690–695.PubMedGoogle Scholar
  25. Guillemot, F., Bouche, B., Gower-Rousseau, C., Chartier, M., Wolschies, E., Lamblin, M. D., et al. (1995). Biofeedback for the treatment of fecal incontinence: Long-term clinical results. Diseases of the Colon and Rectum, 38 ,393–397.PubMedGoogle Scholar
  26. Heah, S. M., Ho, Y. H., Tan, M., & Leong, A. F. (1997). Biofeedback is effective treatment for levator ani syndrome. Diseases of the Colon and Rectum, 40(2), 187–189.PubMedGoogle Scholar
  27. Heymen, S., Jones, K. R., Ringel, Y., Scarlett, Y., & Whitehead, W. E. (2001). Biofeedback treatment of fecal incontinence: A critical review. Diseases of the Colon and Rectum, 44(5), 728–736.PubMedGoogle Scholar
  28. Heymen, S., Jones, K. R., Scarlett, Y., & Whitehead, W. E. (2003). Biofeedback treatment of constipation: A critical review. Diseases of the Colon and Rectum, 46(9), 1208–1217.CrossRefPubMedGoogle Scholar
  29. Heymen, S., Pikarsky, A. J., Weiss, E. G., Vickers, D., Nogueras, J. J., & Wexner, S. D. (2000). A prospective randomized trial comparing four biofeedback techniques for patients with fecal incontinence. Colorectal Disease, 2 ,88–92.CrossRefGoogle Scholar
  30. Heymen, S., Wexner, S. D., Vickers, D., Nogueras, J. J., Weiss, E. G., & Pikarsky, A. J. (1999). Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Diseases of the Colon and Rectum, 42(11), 1388–1393.PubMedGoogle Scholar
  31. Hibi, M., Iwai, N., Kimura, O., Sasaki, Y.,& Tsuda, T. (2003). Results of biofeedback therapy for fecal incontinence in children with encopresis and following surgery for anorectal malformations. Diseases of the Colon and Rectum, 46(Suppl. 10), S54–S58.PubMedGoogle Scholar
  32. Ho, Y., Tan, M., & Goh, H. (1996). Clinical and physiologic effects of biofeedback in outlet obstruction constipation. Diseases of the Colon and Rectum, 39(5), 520–524.PubMedGoogle Scholar
  33. Irvine, E. J., Ferrazzi, S., Pare, P., Thompson, W. G.,& Rance, L. (2002). Health-related quality of life in functional GI disorders: Focus on constipation and resource utilization. American Journal of Gastroenterology, 97(8), 1986–1993.PubMedGoogle Scholar
  34. Jorge, J. M., Habr-Gama, A.,& Wexner, S.D. (2003). Biofeedback therapy in the colon and rectal practice. Applied Psychophysiology and Biofeedback, 28(1), 47–61.CrossRefPubMedGoogle Scholar
  35. Karlbom, U., Hallden, M., Eeg-Olofsson, K. E., Pahlman, L., & Graf, W. (1997). Results of biofeedback in constipated patients: A prospective study. Diseases of the Colon and Rectum, 40(10), 1049–1155.Google Scholar
  36. Kawimbe, B. M., Papachrysostomou, M., Binnie, N. R., Clare, N., & Smith, A. N. (1991). Outlet obstruction constipation (anismus) managed by biofeedback. Gut, 32 ,1175–1179.PubMedGoogle Scholar
  37. Keck, J. O., Staniunas, R. J., Coller, J. A., Barrett, R. C., Oster, M. E., Schoetz, D. J., Jr., et al. (1994). Biofeedback is useful in fecal incontinence but disappointing in constipation. Diseases of the Colon and Rectum, 37 ,1271–1276.PubMedGoogle Scholar
  38. Keren, S., Wagner, Y., Heldenbert, D., & Golan, M. (1998). Studies of manometric abnormalities of the rectoanal region during defecation in constipated and soiling children: Modification through biofeedback therapy. American Journal of Gastroenterology, 83 ,827–831.Google Scholar
  39. Kinnunen, O. (1991). Study of constipation in a geriatric hospital, day hospital, old people's home and at home. Aging, 3 ,161–170.PubMedGoogle Scholar
  40. Ko, C. L., Tong, J., Lehman, R. E., Shelton, A. A., Schrock, T. R.,& Welton, M. L. (1997). Biofeedback is effective therapy for fecal incontinence and constipation. Archives of Surgery, 132 ,829–833.PubMedGoogle Scholar
  41. Koutsomanis, D., Lennard-Jones, J. E., Kamm, M. A. (1994). Prospective study of biofeedback treatment for patients with slow and normal transit constipation. European Journal of Gastroenterology and Hepatology, 6 ,131–137.Google Scholar
  42. Koutsomanis, D., Lennard-Jones, J. E., Roy, A. J., & Kamm, M. A. (1995). Controlled randomized trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Gut, 37 ,95–99.PubMedGoogle Scholar
  43. Latimer, P. R., Campbell, D., & Kasperski, J. A. (1984). Component analysis of biofeedback in the treatment of fecal incontinence. Biofeedback and Self-Regulation, 9 ,311–324.PubMedGoogle Scholar
  44. La Vaque, T. J., Hammond, D. C., Trudeau, D., Monastra, V., Perry, J., Lehrer, P., et al. (2002). Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological interventions. Applied Psychophysiology and Biofeedback, 27 ,273–281. Copublished in Journal of Neurotherapy, 6,11-23.CrossRefPubMedGoogle Scholar
  45. Lestar, B., Penninckx, F., & Kerremans, R. (1991). Biofeedback defecation training for anismus. International Journal of Colorectal Disease, 6 ,202–207.PubMedGoogle Scholar
  46. Loening-Baucke, V. (1990a). Modulation of abnormal defecation dynamics by biofeedback treatment in chronically constipated children with encopresis. Journal of Pediatrics, 116(2), 214–222.PubMedGoogle Scholar
  47. Loening-Baucke, V. (1990b). Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function. Gut, 31(12), 1395–1402.PubMedGoogle Scholar
  48. Loening-Baucke, V. (1991). Persistence of chronic constipation in children after biofeedback treatment. Digestive Diseases and Sciences, 36(2), 153–160.PubMedGoogle Scholar
  49. Loening-Baucke, V. (1995). Biofeedback treatment for chronic constipation and encopresis in childhood: Longterm outcome. Pediatrics, 96(1 Pt. 1), 105–110.PubMedGoogle Scholar
  50. Lowery, S. P., Srour, J. W., Whitehead, W. E., & Schuster, M. M. (1985). Habit training as treatment of encopresis secondary to chronic constipation. Journal of Pediatriatic Gastroenterology and Nutrition, 4(3), 397–401.Google Scholar
  51. MacLennan, A. H., Taylor, A.W., Wilson, D.W.,& Wilson, D. (2000). The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG: An International Journal of Obstetrics and Gyanecology, 107 ,1460–1470.Google Scholar
  52. MacLeod, J. H. (1983). Biofeedback in the management of partial anal incontinence. Diseases of the Colon and Rectum, 26 ,244–246.PubMedGoogle Scholar
  53. MacLeod, J. H. (1987). Management of anal incontinence by biofeedback. Gastroenterology, 93(2), 291–294.PubMedGoogle Scholar
  54. Magrini, P., Pallotta, L., Koch, M., & Capurso, L. (1997). Manometric biofeedback in the management of faecal incontinence and pelvic floor dyssynergia. International Journal of Proctology and Perineal Disease, 1 ,269–270.Google Scholar
  55. Martinez-Puente, M. M., Pascual-Montero, J. A., & Garcia-Olmo, D. (2003). Customized biofeedback therapy improves results in fecal incontinence. International Journal of Colorectal Disease, October 7. (E-publication ahead of print)Google Scholar
  56. McIntosh, L. J., Frahm, J. D., Mallet, V. T., & Richardson, D. A. (1993). Pelvic floor rehabilitation in the treatment of incontinence. The Journal of Reproductive Medicine, 38 ,662–666.PubMedGoogle Scholar
  57. McKee, R. F., McEnroe, L., Anderson, J. H., & Finlay, I. G. (1999). Identification of patients likely to benefit from biofeedback for outlet obstruction constipation. British Journal of Surgery, 86 ,355–359.CrossRefPubMedGoogle Scholar
  58. Miner, P. B., Donnelly, T. C., & Read, N. W. (1990). Investigation of mode of action of biofeedback in treatment of fecal incontinence. Digestive Diseases and Sciences, 35 ,1291–1298.PubMedGoogle Scholar
  59. Miner, P. B. (2004). Economic and personal impact of fecal incontinence. Gastroenterology, 126(Suppl. 1), S8–S13.CrossRefPubMedGoogle Scholar
  60. Nelson, R., Furner, S., & Jesudason, V. (1998). Fecal incontinence in Wisconsin nursing homes: Prevalence and associations. Diseases of the Colon and Rectum, 41 ,1226–1229.PubMedGoogle Scholar
  61. Nelson, R., Norton, N., Cautley E., & Furner, S. (1995). Community-based prevalence of anal incontinence. JAMA, 274 ,559–561.PubMedGoogle Scholar
  62. Nolan, T., Catto-Smith, T., Coffey, C., & Wells, J. (1998). Randomized controlled trial of biofeedback training in persistent encopresis with anismus. Archives of Disease in Childhood, 79 ,131–135.PubMedGoogle Scholar
  63. Norton, C., Chelvanayagam, S., Wilson-Barnett, J., Redfern, S., & Kamm, M. A. (2003). Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology, 125(5), 1320–1329.CrossRefPubMedGoogle Scholar
  64. Norton, C., Hosker G., & Brazelli, M. (2003). Effectiveness of biofeedback and/or sphincter exercises for the treatment of fecal incontinence in adults. Cochrane Electronic Library, 1.Google Scholar
  65. Norton, C., & Kamm, M. A. (2001). Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults—A systematic review. Alimentary Pharmacology and Therapeutics, 15(8), 1147–1154.CrossRefPubMedGoogle Scholar
  66. Olness, K., Mcfarland, F. A., & Piper, J. (1980). Biofeedback: A new modality in management of children with fecal soiling. Journal of Pediatrics, 96(3), 505–509.PubMedGoogle Scholar
  67. Panitch, N. M., & Schofferman, J. A. (1975). Proctalgia fugax revisited [Abstract]. Gastroenterology, 68 ,1061.Google Scholar
  68. Papachrysostomou, M., & Smith, A. N. (1994). Effects of biofeedback on obstructive defecation-Reconditioning of the defecation reflex? Gut, 35 ,252–256.PubMedGoogle Scholar
  69. Patankar, S. K., Ferrara, A., Larach, S.W., Williamson, P. R., Perozo, S. E., Levy, J. R., et al. (1997). Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation. Diseases of the Colon and Rectum, 40(8), 907–911.PubMedGoogle Scholar
  70. Patankar, S. K., Ferrara, A., Levy, J. R., Larach, S. W., Williamson, P. R., & Perozo, S. E. (1997). Biofeedback in colorectal practice: A multicenter, statewide three-year experience. Diseases of the Colon and Rectum, 40(7) 827–831.PubMedGoogle Scholar
  71. Rao, S. S. (2003). Constipation: Evaluation and treatment. Gastroenterolology Clinics of North America, 32(2), 659–683.Google Scholar
  72. Rao, S. S., Enck, P., & Loenig-Baucke, V. (1997). Biofeedback therapy for defecation disorders. Digestive Diseases, 15(Suppl. 1), 78–92.PubMedGoogle Scholar
  73. Rao S. S., Welcher, K. D., & Happel, J. (1996). Can biofeedback therapy improve anorectal function in fecal incontinence? American Journal of Gastroenterology, 91 ,2360–2366.PubMedGoogle Scholar
  74. Rao, S. S., Welcher, K. D., & Pelsang, R. E. (1997). Effects of biofeedback therapy on anorectal function in obstructive defecation. Digestive Diseases and Sciences, 42(11), 2197–2205.CrossRefPubMedGoogle Scholar
  75. Rhee, P. L., Choi, M. S., Kim, Y. H., Son, H. J., Kim, J. J., Koh, K. C., et al. (2000). An increased rectal maximum tolerable volume and long anal canal are associated with poor short-term response to biofeedback therapy for patients with anismus with decreased bowel frequency and normal colonic transit time. Diseases of the Colon and Rectum, 43(10), 1405–1411.PubMedGoogle Scholar
  76. Rieger, N. A., Wattchow, D. A., Sarre, R. G., Cooper, S. J., Rich, C. A., Saccone, G. T., et al. (1997). Prospective trial of pelvic floor retraining in patients with fecal incontinence. Diseases of the Colon and Rectum, 40(7), 821–826.PubMedGoogle Scholar
  77. Rieger, N. A., Wattchow, D. A., Sarre, R. G., Saccone, G. T., Rich, C. A., Cooper, S. J., et al. (1997). Prospective study of biofeedback for treatment of constipation. Diseases of the Colon and Rectum, 40(10) 1143–1148.PubMedGoogle Scholar
  78. Ryn, A.-K., Morren, G. L., Hallbook, O., & Sjodahl, R. (2000). Diseases of the Colon and Rectum, 43(9), 1262–1266.PubMedGoogle Scholar
  79. Sangwan, Y. P., Coller, J. A., Barrett, R. C., Roberts, P. L., Murray, J. J., & Schoetz, D. J., Jr. (1995). Can manometric parameters predict response to biofeedback therapy in fecal incontinence? Diseases of the Colon and Rectum, 38 ,1021–1025.PubMedGoogle Scholar
  80. Schaefeer, C. E. (1979). Childhood encopresis and enuresis: Causes and therapy. New York: Van Nostrand Reinhold.Google Scholar
  81. Sunic-Omejc, M., Mihanovic, M., Bilic, A., Jurcic, D., Restek-Petrovic, B., Maric, N., et al. (2002). Efficiency of biofeedback therapy for chronic constipation in children. Collegium Antropologicum, 26,(Suppl.) 93–101.PubMedGoogle Scholar
  82. Thompson, W. G., & Heaton, K. W. (1980). Proctalgia fugax. Journal of the Royal College of Physicians of London, 14(4), 247–248.PubMedGoogle Scholar
  83. Turnbull, G. K., & Ritvo, P. G. (1992). Anal sphincter biofeedback relaxation treatment for women with intractable constipation. Diseases of the Colon and Rectum, 35 ,530–536.PubMedGoogle Scholar
  84. van der Plas, R. N., Benninga, M. A, Buller, H. A., Bossuyt, P. M., Akkermans, L. M., Redekop, W. K., et al. (1996). Biofeedback training in treatment of childhood constipation: A randomized controlled study. Lancet, 21(348), 776–780.CrossRefGoogle Scholar
  85. van der Plas, R. N., Benninga, M. A., Redekop, W. K., Taminiau, J. A., & Buller, H. A. (1996). Randomised trial of biofeedback training for encopresis. Archives of Disease in Childhood, 75(5), 367–374.PubMedGoogle Scholar
  86. Veyrac, M., Granel, D., Parelon, G., & Michel, H. (1987). Evaluation of biofeedback in childhood idiopathic constipation. Pediatrie, 42(9), 719–721.PubMedGoogle Scholar
  87. Wald, A. (1981). Biofeedback therapy for fecal incontinence. Annals of Internal Medicine, 95 ,146–149.PubMedGoogle Scholar
  88. Wald, A., Caruana, B. J., Freimanis, M. G., Bauman, D. H., & Hinds, J. P. (1990). Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty. Digestive Diseases and Sciences, 35(4), 481–487.PubMedGoogle Scholar
  89. Wald, A., Chandra, R., Gabel, S., & Chiponis, D. (1987). Evaluation of biofeedback in childhood encopresis. Journal of Pediatric Gastroenterology and Nutrition, 6 ,554–558.PubMedGoogle Scholar
  90. Wang, J., Luo, M.H., Qi, Q. H., & Dong, Z. L. (2003). Prospective study of biofeedback retraining in patients with chronic idiopathic functional constipation. World Journal of Gastroenterology, 9(9), 2109–2113.PubMedGoogle Scholar
  91. Weber, J., Ducrotte, P. H., Touchais, J. Y., Roussigno, C., & Denis, R. N. (1987). Biofeedback training for constipation in adults and children. Diseases of the Colon and Rectum, 30(11), 844–846.PubMedGoogle Scholar
  92. Wexner, S. D, Cheape, J. D., Jorge, J. M. N., Heymen, S., & Jagelman, D. G. (1992). Prospective assessment of biofeedback for the treatment of paradoxical puborectalis contraction. Diseases of the Colon and Rectum, 35(2), 145–150.PubMedGoogle Scholar
  93. Whitehead, W. E. (2004). Control groups appropriate for behavioral interventions. Gastroenterology, 126(Suppl. 1), S159–S163.CrossRefPubMedGoogle Scholar
  94. Whitehead, W. E., Burgio, K. L., & Engel, B. T. (1985). Biofeedback treatment of fecal incontinence in geriatric patients. Journal of the American Geriatrics Society, 33 ,320–324.PubMedGoogle Scholar
  95. Whitehead, W. E., Corazziari, E., Prizont, R., Senior, J. R., Thompson, W. G., & Veldhuyzen Van Zanten, S. J. (1999). Definition of a responder in clinical trials for functional gastrointestinal disorders. Report on a symposium. Gut, 45(Suppl. 2), 1178–1179.Google Scholar
  96. Whitehead, W. E., Engel, B. T., & Schuster, M. M. (1980). Irritable bowel syndrome: Physiological and psychological differences between diarrhea-predominant and constipation-predominant patients. Digestive Diseases and Sciences, 25 ,404–413.PubMedGoogle Scholar
  97. Whitehead, W. E., Wald, A., Diamant, N. E., Enck, P., Pemberton, J. H., & Rao, S. S. (2000). Functional disorders of the anus and rectum. In D. A. Drossman, W. Corazziari, N. J. Talley, W. G. Thompson, & W. E. Whitehead (Eds.), Rome II: The functional gastrointestinal disorders (2nd ed., pp. 483–532). McLean, VA: Degnon.Google Scholar
  98. Whitehead, W. E., Wald, A., & Norton N. J. (2001). Treatment options for fecal incontinence. Diseases of the Colon and Rectum, 44(1), 131–142.PubMedGoogle Scholar
  99. Wiesel, P. H., Norton, C., Roy, A., Storrie, J. B., Bowers, J., & Kamm, M. A. (2000). Gut focused behaviour treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry, 69(2), 240–243.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • Olafur S. Palsson
    • 1
  • Steve Heymen
    • 1
  • William E. Whitehead
    • 1
  1. 1.Department of Medicine, Center for Functional Gastrointestinal and Motility DisordersThe University of North Carolina atNorth Carolina

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