Biofeedback-guided pelvic floor exercise therapy for obstructive defecation: An effective alternative

The effect of biofeedback interventions on pain, overall symptoms, quality of life and physiological parameters in patients with pelvic pain : A systematic review

Background

Biofeedback is recognized as an effective additive method for treating certain phenotypes of chronic pelvic pain syndrome and is a therapeutic option in other pelvic pain conditions. This review aims to evaluate evidence from the literature with a focus on the effect of biofeedback on pain reduction, overall symptom relief, physiological parameters and quality of life.

Methods

A systematic literature search was conducted using the databases PubMed, MEDLINE, Embase, Cochrane Library and PEDro from inception to July 2020. Data were tabulated and a narrative synthesis was carried out, since data heterogeneity did not allow a meta-analysis. The PEDro scale and the McMaster Critical Review Form—Quantitative Studies were applied to assess risk of bias.

Results

Out of 651 studies, 37 quantitative studies of primary research evaluating pelvic pain conditions in male and female adults and children were included. They covered biofeedback interventions on anorectal disorders, chronic prostatitis, female chronic pelvic pain conditions, urologic phenotypes in children and adults and a single study on low back pain. For anorectal disorders, several landmark studies demonstrate the efficacy of biofeedback. For other subtypes of chronic pelvic pain conditions there is tentative evidence that biofeedback-assisted training has a positive effect on pain reduction, overall symptoms relief and quality of life. Certain factors have been identified that might be relevant in improving treatment success.

Conclusions

For certain indications, biofeedback has been confirmed to be an effective treatment. For other phenotypes, promising findings should be further investigated in robust and well-designed randomized controlled trials.

Efficacy and Predictors for Biofeedback Therapeutic Outcome in Patients with Dyssynergic Defecation

Aim

To evaluate the short-term efficacy of biofeedback therapy (BFT) for dyssynergic defecation (DD) and to explore the predictors of the efficacy of BFT.

Methods

Clinical symptoms, psychological state, and quality of life of patients before and after BFT were investigated. All patients underwent lifestyle survey and anorectal physiology tests before BFT. Improvement in symptom scores was considered proof of clinical efficacy of BFT. Thirty-eight factors that could influence the efficacy of BFT were studied. Univariate and multivariate analysis was conducted to identify the independent predictors.

Results

Clinical symptoms, psychological state, and quality of life of DD patients improved significantly after BFT. Univariate analysis showed that efficacy of BFT was positively correlated to one of the 36-item Short-Form Health Survey terms, the physical role function (r = 0.289; P = 0.025), and negatively correlated to the stool consistency (r = −0.220; P = 0.032), the depression scores (r = −0.333; P = 0.010), and the first rectal sensory threshold volume (r = −0.297; P = 0.022). Multivariate analysis showed depression score (β = −0.271; P = 0.032) and first rectal sensory threshold volume (β = −0.325; P = 0.013) to be independent predictors of BFT efficacy.

Conclusion

BFT improves the clinical symptoms of DD patients. Depression state and elevated first rectal sensory threshold volume were independent predictors of poor outcome with BFT.

Intractable Constipation in the Elderly

OPINION STATEMENT

Chronic constipation is a common gastrointestinal disorder disproportionately affecting the elderly. Immobility, polypharmacy, and physiologic changes contribute to its increased prevalence in this population. Unidentified and undertreated constipation leads to a significant negative impact on quality of life and an increase in healthcare spending. Careful physical examination and exploration of the clinical history can unmask primary and secondary forms of constipation, guiding diagnostic and therapeutic considerations. Non-pharmacologic treatment options include bowel training and biofeedback as well as the addition of fiber. Laxatives are safe and can be used long term; thus, they remain the mainstay of therapy. Newer agents with specific physiologic targets have proven to be effective in adults with chronic constipation, but data is lacking for safety profile in the elderly. Consideration for surgery in medically refractory cases should be entertained, while use of neuromodulation is not ready for prime time. This is a review of the currently available treatment options for chronic constipation in adults and specifically tailored towards the elderly.