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Therapeutic Application of Manometry: Biofeedback for Management of Fecal Evacuation Disorders

  • Tanisa Patcharatrakul
  • Sutep GonlachanvitEmail author
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Abstract

Anorectal dyssynergia is an important cause of defecation disorder, especially among patients with chronic primary constipation. Patients with this condition have an incoordination of abdominal wall muscles and pelvic floor during bearing down, which results in impaired evacuation. Dietary modification, lifestyle modification, and laxatives—which are the standard treatment of constipation—are not able to correct the pathophysiology of this condition.

Biofeedback has been recommended as the treatment of choice for this condition. It is an instrument-based behavioral learning process and has demonstrated a superior benefit over standard treatment or laxatives in several randomized controlled trials. This treatment improves constipation and overall symptoms, as well as dyssynergic pattern of defecation, and showed a long-term efficacy. To date, the biofeedback treatment protocol has not been standardized and a wide variety of techniques have been reported, with insufficient data to determine the most effective modality. In this review, we focus on a manometry-based biofeedback method which measures the pressure at the rectum that represents the propulsive or pushing force, and anal sphincter pressure that represents the sphincter relaxation or contraction. We thoroughly describe the practical biofeedback technique for dyssynergic constipation patients that has been used in our center. Although only studies of biofeedback therapy from Asian countries have been reviewed, the response rate in our center and other centers in Asia was comparable to the western studies.

Keywords

Biofeedback therapy Constipation Defecation disorder Dyssynergic defecation Evacuation disorder 

References

  1. 1.
    Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol. 2011;25(1):3–18.CrossRefPubMedGoogle Scholar
  2. 2.
    Mertz H, Naliboff B, Mayer E. Physiology of refractory chronic constipation. Am J Gastroenterol. 1999;94(3):609–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum. 1997;40(3):273–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Patcharatrakul T, Gonlachanvit S. Outcome of biofeedback therapy in dyssynergic defecation patients with and without irritable bowel syndrome. J Clin Gastroenterol. 2011;45(7):593–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Wald A, Sigurdsson L. Quality of life in children and adults with constipation. Best Pract Res Clin Gastroenterol. 2011;25(1):19–27.CrossRefPubMedGoogle Scholar
  6. 6.
    Surrenti E, Rath DM, Pemberton JH, Camilleri M. Audit of constipation in a tertiary referral gastroenterology practice. Am J Gastroenterol. 1995;90(9):1471–5.PubMedGoogle Scholar
  7. 7.
    Tantiphlachiva K, Rao P, Attaluri A, Rao SS. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol. 2010;8(11):955–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Bleijenberg G, Kuijpers HC. Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum. 1987;30(2):108–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5(3):331–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial. Am J Gastroenterol. 2010;105(4):890–6.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum. 2007;50(4):428–41.CrossRefPubMedGoogle Scholar
  12. 12.
    Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130(3):657–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Tack J, Muller-Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, et al. Diagnosis and treatment of chronic constipation--a European perspective. Neurogastroenterol Motil. 2011;23(8):697–710.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gwee KA, Ghoshal UC, Gonlachanvit S, Chua AS, Myung SJ, Rajindrajith S, et al. Primary care management of chronic constipation in Asia: the ANMA chronic constipation tool. J Neurogastroenterol Motil. 2013;19(2):149–60.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Shin JK, Cheon JH, Kim ES, Yoon JY, Lee JH, Jeon SM, et al. Predictive capability of anorectal physiologic tests for unfavorable outcomes following biofeedback therapy in dyssynergic defecation. J Korean Med Sci. 2010;25(7):1060–5.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Zhu FF, Lin Z, Lin L, Wang MF. Changes in quality of life during biofeedback for people with puborectalis dyssynergia: generic and disease-specific measures. J Adv Nurs. 2011;67(6):1285–93.CrossRefPubMedGoogle Scholar
  18. 18.
    Rao SS. Dyssynergic defecation and biofeedback therapy. Gastroenterol Clin North Am. 2008;37(3):569–86, viii.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bleijenberg G, Kuijpers HC. Biofeedback treatment of constipation: a comparison of two methods. Am J Gastroenterol. 1994;89(7):1021–6.PubMedGoogle Scholar
  20. 20.
    Glia A, Gylin M, Gullberg K, Lindberg G. Biofeedback retraining in patients with functional constipation and paradoxical puborectalis contraction: comparison of anal manometry and sphincter electromyography for feedback. Dis Colon Rectum. 1997;40(8):889–95.CrossRefPubMedGoogle Scholar
  21. 21.
    Heymen S, Wexner SD, Vickers D, Nogueras JJ, Weiss EG, Pikarsky AJ. Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Dis Colon Rectum. 1999;42(11):1388–93.CrossRefPubMedGoogle Scholar
  22. 22.
    Koutsomanis D, Lennard-Jones JE, Roy AJ, Kamm MA. Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Gut. 1995;37(1):95–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Patankar SK, Ferrara A, Levy JR, Larach SW, Williamson PR, Perozo SE. Biofeedback in colorectal practice: a multicenter, statewide, three-year experience. Dis Colon Rectum. 1997;40(7):827–31.CrossRefPubMedGoogle Scholar
  24. 24.
    Kawimbe BM, Papachrysostomou M, Binnie NR, Clare N, Smith AN. Outlet obstruction constipation (anismus) managed by biofeedback. Gut. 1991;32(10):1175–9.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Rao SS, Welcher KD, Pelsang RE. Effects of biofeedback therapy on anorectal function in obstructive defecation. Dig Dis Sci. 1997;42(11):2197–205.CrossRefPubMedGoogle Scholar
  26. 26.
    Farid M, El Monem HA, Omar W, El Nakeeb A, Fikry A, Youssef T, et al. Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients. Int J Colorectal Dis. 2009;24(1):115–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Faried M, El Nakeeb A, Youssef M, Omar W, El Monem HA. Comparative study between surgical and non-surgical treatment of anismus in patients with symptoms of obstructed defecation: a prospective randomized study. J Gastrointest Surg. 2010;14(8):1235–43.CrossRefPubMedGoogle Scholar
  28. 28.
    Kunimoto M, Nishi M, Sasaki K. The relation between irregular bowel movement and the lifestyle of working women. Hepatogastroenterology. 1998;45(22):956–60.PubMedGoogle Scholar
  29. 29.
    Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000;89(3):967–76.PubMedGoogle Scholar
  30. 30.
    Gladman MA, Scott SM, Chan CL, Williams NS, Lunniss PJ. Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and fecal incontinence. Dis Colon Rectum. 2003;46(2):238–46.CrossRefPubMedGoogle Scholar
  31. 31.
    Read NW, Timms JM, Barfield LJ, Donnelly TC, Bannister JJ. Impairment of defecation in young women with severe constipation. Gastroenterology. 1986;90(1):53–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Schouten WR, Gosselink MJ, Boerma MO, Ginai AZ. Rectal wall contractility in response to an evoked urge to defecate in patients with obstructed defecation. Dis Colon Rectum. 1998;41(4):473–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol. 1998;93(7):1042–50.CrossRefPubMedGoogle Scholar
  34. 34.
    Prott G, Shim L, Hansen R, Kellow J, Malcolm A. Relationships between pelvic floor symptoms and function in irritable bowel syndrome. Neurogastroenterol Motil. 2010;22(7):764–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Sabate JM, Veyrac M, Mion F, Siproudhis L, Ducrotte P, Zerbib F, et al. Relationship between rectal sensitivity, symptoms intensity and quality of life in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2008;28(4):484–90.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology. 1995;109(1):40–52.CrossRefPubMedGoogle Scholar
  37. 37.
    Heymen S, Jones KR, Scarlett Y, Whitehead WE. Biofeedback treatment of constipation: a critical review. Dis Colon Rectum. 2003;46(9):1208–17.CrossRefPubMedGoogle Scholar
  38. 38.
    Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology. 2005;129(1):86–97.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Department of Medicine, Division of Gasteroenterology, Faculty of MedicineKing Chulalongkorn Memorial Hospital, Chulalongkorn UniversityPathumwan, BangkokThailand
  2. 2.Gastrointestinal Motility Research Unit, Division of Gastroenterology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityPathumwan, BangkokThailand

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