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Techniques in Coloproctology
Published in: Techniques in Coloproctology 9/2020

01-09-2020 | Constipation | Review

A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults

Authors: D. Moore, C. J. Young

Published in: Techniques in Coloproctology | Issue 9/2020

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Abstract

Background

Dyssynergic defaecation is a common form of functional constipation that responds poorly to conservative interventions. This systematic review and meta-analysis assesses the effectiveness of biofeedback therapy for dyssynergic defaecation using global clinical improvement as the primary outcome, and resolution of the dyssynergic pattern on anorectal physiology and quality of life as secondary outcomes.

Methods

MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Scopus, and Web of Science were searched from inception to March 2019 using a predefined strategy. Randomised controlled trials of adult patients with dyssynergic defaecation and a biofeedback treatment arm were eligible for review. Studies including patients with secondary forms of constipation were excluded. Data abstraction and risk of bias assessments were conducted by consensus between two authors.

Results

Eleven trials including 725 participants were included in the narrative review. Sixty-three percent of patients treated with biofeedback reported clinical improvement. Six studies included in the meta-analysis showed biofeedback superior to non-biofeedback therapy for the primary outcome (OR 3.63, CI 1.10–11.93, p = 0.03). Heterogeneity between trials and overall risk of bias was high.

Conclusions

Biofeedback therapy is recommended for patients referred to tertiary units with dyssynergic defaecation who fail conservative therapy. Future research should be directed towards identifying validated outcomes and the optimum method for delivering biofeedback therapy. Home biofeedback therapy may improve accessibility and recruitment to future clinical trials.
Literature
1.
Black CJ, Ford AC (2018) Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management. Med J Aust 209(2):86–91
2.
Suares NC, Ford AC (2011) Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol 106:1582CrossRef
3.
4.
Rao SS, Tuteja AK, Vellema T, Kempf J, Stessman M (2004) Dyssynergic defecation: demographics, symptoms, stool patterns, and quality of life. J Clin Gastroenterol 38(8):680–685CrossRef
5.
Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P (2014) Characteristics of functional bowel disorder patients: a cross-sectional survey using the Rome III criteria. Aliment Pharmacol Ther 39(3):312–321CrossRef
6.
Vazquez Roque M, Bouras EP (2015) Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging 10:919–930PubMedPubMedCentral
7.
Rao SSC, Seaton K, Miller MJ, Schulze K, Brown CK, Paulson J et al (2007) Psychological profiles and quality of life differ between patients with dyssynergia and those with slow transit constipation. J Psychosom Res 63(4):441–449CrossRef
8.
Wald A, Scarpignato C, Kamm MA, Mueller-Lissner S, Helfrich I, Schuijt C et al (2007) The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther 26(2):227–236CrossRef
9.
Dennison C, Prasad M, Lloyd A, Bhattacharyya SK, Dhawan R, Coyne KJP (2005) The health-related quality of life and economic burden of constipation. Pharmacoeconomics 23(5):461–476
10.
Voderholzer WA, Schatke W, Muhldorfer BE, Klauser AG, Birkner B, Muller-Lissner SA (1997) Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol 92(1):95–98PubMed
11.
Muller-Lissner SA, Kamm MA, Scarpignato C, Wald A (2005) Myths and misconceptions about chronic constipation. Am J Gastroenterol 100(1):232–242CrossRef
12.
Pinho M, Yoshioka K, Keighley MR (1989) Long term results of anorectal myectomy for chronic constipation. Br J Surg 76(11):1163–1164CrossRef
13.
Barnes PR, Hawley PR, Preston DM, Lennard-Jones JE (1985) Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Br J Surg 72(6):475–477CrossRef
14.
Maria G, Cadeddu F, Brandara F, Marniga G, Brisinda G (2006) Experience with type A botulinum toxin for treatment of outlet-type constipation. Am J Gastroenterol 101(11):2570–2575CrossRef
15.
El-Tawil AM (2004) Reasons for creation of permanent ileostomy for the management of idiopathic chronic constipation. J Gastroenterol Hepatol 19(8):844–846CrossRef
16.
Rao SSC, Benninga MA, Bharucha AE, Chiarioni G, Di Lorenzo C, Whitehead WE (2015) ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motility Off J Eur Gastrointest Motility Soc 27(5):594–609CrossRef
17.
Koh CE, Young CJ, Young JM, Solomon MJ (2008) Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. Br J Surg 95(9):1079–1087CrossRef
18.
19.
Enck P, Van Der Voort IR, Klosterhalfen S (2009) Biofeedback therapy in fecal incontinence and constipation. Neurogastroenterol Motil 21(11):1133–1141
20.
Chiarelli P (2008) Systematic review: the management of constipation using physical therapies including biofeedback. Aust N Zeal Continence J 14(1):6–13
21.
22.
The Nordic Cochrane Centre, The Cochrane Collaboration (2014) Review manager (RevMan). Version 5.3. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen
23.
Aba-bai-ke-re M, Wen NR, Hu YL, Zhao L, Tuxun T, Husaiyin A et al (2014) Biofeedback-guided pelvic floor exercise therapy for obstructive defecation: an effective alternative. World J Gastroenterol 20(27):9162–9169
24.
Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G (2006) Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 130(3):657–664CrossRef
25.
Faried M, El Monem HA, Omar W, El Nakeeb A, Fikry A, Youssef T et al (2009) Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients. Int J Colorectal Dis 24(1):115–120CrossRef
26.
Faried M, El Nakeeb A, Youssef M, Omar W, El Monem HA (2010) Comparative study between surgical and non-surgical treatment of anismus in patients with symptoms of obstructed defecation: a prospective randomized study. J Gastrointest Surg Off J Soc Surg Aliment Tract 14(8):1235–1243CrossRef
27.
Gong BY, Ma HM, Zang XY, Wang SY, Zhang Y, Jiang N et al (2016) Efficacy of cranial electrotherapy stimulation combined with biofeedback therapy in patients with functional constipation. J Neurogastroenterol Motility 22(3):497–508CrossRef
28.
Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE (2007) Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum 50(4):428–441CrossRef
29.
Pourmomeny AA, Emami MH, Amooshahi M, Adibi P (2011) Comparing the efficacy of biofeedback and balloon-assisted training in the treatment of dyssynergic defecation. Can J Gastroenterol Journal canadien de gastroenterologie 25(2):89–92CrossRef
30.
Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P et al (2007) Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 5(3):331–338
31.
Rao SSC, Valestin JA, Xiang X, Hamdy S, Bradley CS, Zimmerman MB (2018) Home-based versus office-based biofeedback therapy for constipation with dyssynergic defecation: a randomised controlled trial. Lancet Gastroenterol Hepatol 3(11):768–777CrossRef
32.
Simón MA, Bueno AM (2009) Behavioural treatment of the dyssynergic defecation in chronically constipated elderly patients: a randomized controlled trial. Appl Psychophysiol Biofeedback 34(4):273–277CrossRef
33.
Simón MA, Bueno AM (2017) Efficacy of biofeedback therapy in the treatment of dyssynergic defecation in community-dwelling elderly women. J Clin Gastroenterol 51(10):e90–e94CrossRef
34.
Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39(6):681–685CrossRef
35.
Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K (2010) Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial. Am J Gastroenterol 105(4):890–896CrossRef
Metadata
Title
A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults
Authors
D. Moore
C. J. Young
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 9/2020
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-020-02230-9

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