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

  • Tanisa Patcharatrakul
  • Sutep GonlachanvitEmail author


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.


Biofeedback therapy Constipation Defecation disorder Dyssynergic defecation Evacuation disorder 


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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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