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Biofeedback Therapy in the Colon and Rectal Practice

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Abstract

In coloproctology, biofeedback has been used for more than 20 years to treat patients with fecal incontinence, constipation, and rectal pain. It can be performed in a number of conditions with minimal risk and discomfort. However, it does require the presence of some degree of sphincter contraction and rectal sensitivity. Biofeedback can be time-consuming and demands motivation. The purpose of this paper is to review the indications, methodology, and results of anorectal biofeedback in the treatment of these disorders. Mean success rates for biofeedback range from 72.3% for fecal incontinence of diverse etiology, 68.5% for constipation attributable to paradoxical puborectalis syndrome, and 41.2% for idiopathic rectal pain. However, criteria to define success vary tremendously among researchers and there is a tendency to indicate biofeedback in a myriad of conditions when other therapeutic options, including surgery, fail or are inappropriate. These factors make comparison of the results difficult and reinforce the need for randomized controlled trials and studies assessing long-term follow-up. In summary, biofeedback is a simple, cost-effective, and morbidity-free technique and remains an attractive option, especially considering the complexity of the functional disorders of the colon, rectum, anus, and pelvic floor.

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REFERENCES

  • Agachan, F., Chen, T., Pfeifer, J., Reissman, P., & Wexner, S. D. (1996). A constipation scoring system to simplify evaluation and management of constipated patients. Diseases of the Colon and Rectum, 39, 681-685.

    Google Scholar 

  • Beninga, M. A., Buller, H. A., & Taminiau, J. A. A. (1993). Biofeedback training in chronic constipation. Archives of Disease in Childhood, 68, 126-129.

    Google Scholar 

  • Berti Riboli, E., Frascio, M., Pitto, G., Reboa, G., & Zanolla, R. (1988). Biofeedback conditioning for faecal incontinence. Archives of Physical Medicine and Rehabilitation, 69, 29-31.

    Google Scholar 

  • Bleijenberg, G., & Kuijpers, H. C. (1987). Treatment of spastic pelvic floor syndrome with biofeedback. Diseases of the Colon and Rectum, 30, 108-111.

    Google Scholar 

  • Bleijenberg, G., & Kuijpers, H. C. (1994). Biofeedback treatment of constipation: A comparison of two methods. American Journal of Gastroenterology, 89, 1021-1026

    Google Scholar 

  • Brodén, G., Dolk, A., Frostell, C., Nilsson, B., & Holmstrom, B. (1989). Voluntary relaxation of the external anal sphincter. Diseases of the Colon and Rectum, 32, 376-378.

    Google Scholar 

  • Buser, W. D., & Miner, P. B., Jr. (1986). Delayed rectal sensation with fecal incontinence. Gastroenterology, 91, 1186-1191.

    Google Scholar 

  • Cerulli, M. A., Nikoomanesh, P., & Schuster, M. M. (1979). Progress in biofeedback conditioning for fecal incontinence. Gastroenterology, 76, 742-746.

    Google Scholar 

  • 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, 769-776.

    Google Scholar 

  • Dolk, A., Holmstrom, B., Johansson, C., Frostell, C., & Nilsson, B. Y. (1991). The effect of yoga on puborectalis paradox. International Journal of Colorectal Disease, 6, 139-142.

    Google Scholar 

  • 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, 997-1001.

    Google Scholar 

  • Engel, B. T., Nikoomanesh, P., & Schuster, M. M. (1974). Operant conditioning for rectosphincteric responses in the treatment of fecal incontinence. New England Journal of Medicine, 290, 646-649.

    Google Scholar 

  • 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.

    Google Scholar 

  • Ger, G. C., Wexner, S. D., Jorge, J. M. N., 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, 139-145.

    Google Scholar 

  • Gilliland, R., Heymen, S., Altomare, D. F., Park, U. C., Vickers, D., & Wexner, S. D. (1997a). Outcome and predictors of success of biofeedback for constipation. British Journal of Surgery, 84, 1123-1126.

    Google Scholar 

  • Gilliland, R., Heymen, J. S., Altomare, D. F., Vickers, D., & Wexner, S. D. (1997b). Biofeedback for intractable rectal pain: Outcome and predictors of success. Diseases of the Colon and Rectum, 40, 190-196.

    Google Scholar 

  • Glia, A., Gylin, M., Akerlund, J. E., Lindfors, U., & Lindberg, G. (1998). Biofeedback training in patients with fecal incontinence. Diseases of the Colon and Rectum, 41, 359-364.

    Google Scholar 

  • Glia, A., Gylin, M., Gullberg, K., & Lindberg, G. (1997). Biofeedback retraining in patients with functional constipation and paradoxical puborectalis contraction: Comparison of anal manometry and sphincter electromyography for feedback. Diseases of the Colon and Rectum, 40, 889-895.

    Google Scholar 

  • Goldenberg, D. A., Hodges, K., Hersh, T., & Jinich, H. (1980). Biofeedback therapy for faecal incontinence. American Journal of Gastroenterology, 74, 342-345.

    Google Scholar 

  • 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, 690-695.

    Google Scholar 

  • 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.

    Google Scholar 

  • Hallan, R. I., Williams, N. S., Melling, J., Waldron, D. J., Womack, N. R., & Morrison, J. F. (1988). Treatment of anismus in intractable constipation with botulinum A toxin. Lancet, 2, 714-717.

    Google Scholar 

  • Hamalainen, K.-P. J., Raivio, P., Antila, S., Palmu, A., & Mecklin, P.-J. (1996). Biofeedback therapy in rectal prolapse patients. Diseases of the Colon and Rectum, 39, 262-265.

    Google Scholar 

  • Heah, S.-M., Ho, Y.-H., Tan, M., & Leong, A. F. P. K. (1997). Biofeedback is effective treatment for levator ani syndrome. Diseases of the Colon and Rectum, 40, 187-189.

    Google Scholar 

  • Herold, A., Bruch, H.-P., Dorsing, C., & Oberhollenzer, A. (1992). Coordination dysfunction of the external anal sphincter: Diagnosis and conservative biofeedback treatment. Coloproctology, 14(4), 235-238.

    Google Scholar 

  • 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, 1388-1393.

    Google Scholar 

  • Ho, Y.-H., Chiang, J.-M., Tan, M., & Low, J. Y. (1996). Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy. Diseases of the Colon and Rectum, 39, 1289-1292.

    Google Scholar 

  • Hull, T. L., Fazio, V. W., & Schroeder, T. (1995). Paradoxical puborectalis contraction in patients after pelvic pouch construction. Diseases of the Colon and Rectum, 38, 1144-1146.

    Google Scholar 

  • Jensen, L. L., & Lowry, A. C. (1993). Are pudendal nerve latencies a predictive factor in the success of biofeedback for fecal incontinence. Diseases of the Colon and Rectum, 36, p. 30.

    Google Scholar 

  • Jensen, L. L., & Lowry, A. C. (1997). Biofeedback improves functional outcome after sphincteroplasty. Diseases of the Colon and Rectum, 40, 197-200.

    Google Scholar 

  • Jorge, J. M. N., & Wexner, D. S. (1993). Etiology and management of fecal incontinence. Diseases of the Colon and Rectum, 36, 77-97.

    Google Scholar 

  • Jorge, J. M. N., & Wexner, S. D. (1995). Physiologic evaluation. In S. D., Wexner, & A. M., Vernava, (Eds.), Clinical decision making in colorectal surgery, (pp. 11-22). New York: IGAKU-SHOIN.

    Google Scholar 

  • Jorge, J. M. N., Wexner, S. D., Ger, G. C., Salanga, V. D., Nogueras, J. J., & Jagelman, D. G. (1993). Cinedefecography and electromyography in the diagnosis of nonrelaxing puborectalis syndrome. Diseases of the Colon and Rectum, 36, 668-676.

    Google Scholar 

  • 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, 1149-1155.

    Google Scholar 

  • Keck, J. O., Staniunas, R. J., Coller, J. A., Barrett, R. C., Oster, M. E. E., Schoetz, D. J., Jr., et al. (1994). Biofeedback training is useful in fecal incontinence but dispointing in constipation. Diseases of the Colon and Rectum, 37, 1271-1276.

    Google Scholar 

  • Ko, C. Y., 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, 829-834.

    Google Scholar 

  • Launer, D. P., Fazio, V. W., Weakly, F. L., Turnhull, R. B., Jr., Jagelman, D. G., & Lavery, I. C. (1982). The Ripstein procedure: A 16-year experience. Diseases of the Colon and Rectum, 25, 41-45.

    Google Scholar 

  • Leroi, A. M., Dorival, M.-P., Lecouturier, M.-F., Saiter, C., Weter, M.-L., Touchais, J.-Y., et al. (1999). Pudendal neuropathy and severity of incontinence but not presence of anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Diseases of the Colon and Rectum, 42, 762-769.

    Google Scholar 

  • Leroi, A. M., Duval, V., Roussignol, C., Berkelmans, I., Peninque, P., & Denis, P. (1996). Biofeedback for anismus in 15 sexually abused women. International Journal of Colorectal Disease, 11, 187-190.

    Google Scholar 

  • Lestàr, B., Penninckx, F., & Kerremans, R. (1991). Biofeedback defaecation training for anismus. International Journal of Colorectal Disease, 6, 202-207.

    Google Scholar 

  • Loening-Baucke, V. (1990a). Biofeedback therapy for fecal incontinence. Digestive Diseases and Sciences, 7, 112-124.

    Google Scholar 

  • Loening-Baucke, V. (1990b). Modulation of abnormal defecation dynamics by biofeedback treatment in chronically constipated children with encopresis. Journal of Pediatrics, 116, 214-222.

    Google Scholar 

  • Loening-Baucke, V. (1995). Biofeedback treatment for chronic constipation and encopresis in childhood: Long-term outcome. Pediatrics, 96, 105-110.

    Google Scholar 

  • McLeod, J. (1987). Management of anal incontinence by biofeedback. Gastroenterology, 93, 291-294.

    Google Scholar 

  • 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.

    Google Scholar 

  • Papachrysostomou, A. N., & Smith, A. N. (1994). Effects of biofeedback on obstructive defecation-reconditioning of the defecation reflex? Gut; 35, 252-256.

    Google Scholar 

  • Park, U. C., Choi, S. K., Piccirillo, M. F., Verzaro, R., & Wexner, S. D. (1996). Patterns of anismus and the relation to biofeedback therapy. Diseases of the Colon and Rectum, 39, 768-773.

    Google Scholar 

  • Patankar, S. K., Ferrara, A., Larach, S. W., Williamson, P. R., Perozo, S. E., Levy, J. R., et al. (1997a). Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation. Diseases of the Colon and Rectum, 40, 907-911.

    Google Scholar 

  • Patankar, S. K., Ferrara, A., Levy, J. R., Larach, S. W., Williamson, P. R., & Perozo, S. E. (1997b). Biofeedback in colorectal practice: A multicenter, statewide, three-year experience. Diseases of the Colon and Rectum, 40, 827-831.

    Google Scholar 

  • Reboa, G., Frascio, M., Zanolla, R., Pitto, G., & Riboli, E. (1985). Biofeedback training to obtain continence in permanent colostomy. Diseases of the Colon and Rectum, 28, 419-421.

    Google Scholar 

  • Rieger, N. A., Wattchow, D. A., Sarre, R. G., Cooper, S. J., Rich, C. A., Saccone, G. T. P., et al. (1997a). Prospective trial of pelvic floor training in patients with fecal incontinence. Diseases of the Colon and Rectum, 40, 821-826.

    Google Scholar 

  • Rieger, N. A., Wattchow, D. A., Sarre, R. G., Saccone, G. T. P., Rich, C. A., Cooper, S. J., et al. (1997b). Prospective study of biofeedback for treatment of constipation. Diseases of the Colon and Rectum, 40, 1143-1148.

    Google Scholar 

  • 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.

    Google Scholar 

  • Sielezneff, I., Sarles, J. C., & Sastre, B. (1994). Dyssynergie anorectale. Données cliniques, manométriques et thérapeutiques. Press Medicale, 23, 1691-1694.

    Google Scholar 

  • Siproudhis, L., Dautreme, S., Ropert, A., Briand, H., Renet, C., Beusnel, C., et al. (1995). Anismus in biofeedback: Who benefits? European Journal of Gastroenterology and Hepatology, 7, 547-552.

    Google Scholar 

  • Sousa, A., Jr., Araujo, S. A., Damico, F. M., Cordeiro, A. C., Pinotti, H. W., & Gama, A. H. (1994). Manometric findings prior to and after biofeedback for anal incontinence. Diseases of the Colon and Rectum, 37, p. 24.

    Google Scholar 

  • Turnbull, G. K., & Ritvo, P. G. (1992). Anal sphincter biofeedback relaxation treatment for women with intractable constipation symptoms. Diseases of the Colon and Rectum, 35, 530-536.

    Google Scholar 

  • 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, 367-374.

    Google Scholar 

  • Van Tets, W. F., Kuijpers, J. H. C., & Bleijenberg, G. (1996). Biofeedback treatment is ineffective on neurogenic fecal incontinence in neurogenic fecal incontinence. Diseases of the Colon and Rectum, 39, 992-994.

    Google Scholar 

  • Wald, A. (1981). Biofeedback therapy for fecal incontinence. Ann Intern Med, 95, 146-149.

    Google Scholar 

  • Wald, A. (1983). Biofeedback for neurogenic fecal incontinence: Rectal sensation is a determinant of outcome. Journal of Pediatric Gastroenterology and Nutrition, 2, 302-306.

    Google Scholar 

  • Wald, A., & Tunuguntla, A. K. (1984). Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. New England Journal of Medicine, 310, 1282-1287.

    Google Scholar 

  • Wasserman, I. F. (1964). Puborectalis syndrome (rectal stenosis due to anorectal spasm). Diseases of the Colon and Rectum, 7, 87-89.

    Google Scholar 

  • Watts, J. D., Rothenberger, D. A., Buls, J. G., Goldberg, S. M., & Nivatvongs, S. (1985). The management of procidentia: 30 year's experience. Diseases of the Colon and Rectum, 28, 96-102.

    Google Scholar 

  • Weber, J., Ducrotte, P. H., Touchais, J. Y., Roussignol, C., & Denis, P. H. (1987). Biofeedback training for constipation in adults and children. Diseases of the Colon and Rectum, 30, 844-846.

    Google Scholar 

  • 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, 145-150.

    Google Scholar 

  • Wexner, S. D., & Jorge, J. M. N. (1994). Colorectal physiological tests: Use or abuse of technology? European Journal of Surgery, 160, 167-174.

    Google Scholar 

  • Whitehead, W. E., Burgio, K., & Engel, B. T. (1985). Biofeedback treatment of faecal incontinence in geriatric patients. Journal of American Geriatric Society, 33, 320-324.

    Google Scholar 

  • Whitehead, W. E., Parker, L. H., Masek, B. J., Cataldo, M. F., & Freeman, J. M. (1981). Biofeedback treatment of fecal incontinence in patients with myelomeningocele. Developmental Medicine and Child Neurology, 23, 313-322.

    Google Scholar 

  • Yoshioka, K., & Keighley, M. R. (1987). Anorectal myectomy for outlet obstruction. British Journal of Surgery, 74, 373-376.

    Google Scholar 

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Authors and Affiliations

  1. Department of Coloproctology, University of São Paulo, São Paulo, Brazil

    Jose Marcio N. Jorge & Angelita Habr-Gama

  2. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida

    Steven D. Wexner

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  1. Jose Marcio N. Jorge
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  2. Angelita Habr-Gama
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  3. Steven D. Wexner
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Correspondence to Steven D. Wexner.

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Jorge, J.M.N., Habr-Gama, A. & Wexner, S.D. Biofeedback Therapy in the Colon and Rectal Practice. Appl Psychophysiol Biofeedback 28, 47–61 (2003). https://doi.org/10.1023/A:1022316900628

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