Biofeedback is a treatment method that uses monitoring devices and information to help people consciously control physical processes such as heart rate, blood pressure, temperature, sweating, and muscle tension that are usually controlled automatically. Biofeedback therapy for constipation focuses on training the person to relax the pelvic floor and anal sphincter. Different types of equipment can be used, such as balloons inserted into the rectum and electrical devices to determine muscle contraction. Biofeedback for constipation has not been specifically studied in patients with cancer.
Koh, C.E., Young, C.J., Young, J.M., & Solomon, M.J. (2008). Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. British Journal of Surgery, 95, 1079–1087.
To determine whether biofeedback improves outcomes for patients with pelvic floor dysfunction (PFD), and to assess the relative effectiveness of different types of biofeedback therapy.
Databases searched were CINAHL, Embase, Medline, PsycINFO, Evidence-Based Medicine Reviews (EBMR), and the Cochrane Database. References of retrieved articles also were hand searched.
Search keywords were constipation, anismus, dyssynergia, obstructive defecation, rectocele, rectal intussusception, rectal prolapse, and biofeedback.
Studies were included in the review if they
Studies were excluded from the review if they reported on pediatric cases.
The initial searching provided 5,028 references. Study selection and screening for inclusion criteria provided a final set of seven studies. Study quality was evaluated by two reviewers.
Additional, better-designed studies are needed in this area to determine efficacy. Future studies should compare different biofeedback modalities to identify the most effective approaches.
Chiarioni, G., Salandini, L., & Whitehead, W.E. (2005). Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology, 129, 86–97.
To compare the efficacy of biofeedback in pelvic function dyssynergia–induced constipation (PFD) versus slow transit constipation (STC).
All subjects received five weekly biofeedback lessons and were assessed at 1, 6, 12, and 24 months.
Gastroenterology Clinic of the Division of Gastrointestinal Rehabilitation of the University of Verona in Valeggio sul Mincio, Italy
This was a quasi-experimental study.
At six months, greater improvements were seen in patients with PFD compared to those with STC: 71% versus 8% reported improved satisfaction (p = 0.001), and 76% versus 8% reported three or more bowel movements per week (p ≤ 0.001).
Patients with PFD received greater benefit from biofeedback than those with STC.
Chiarioni, G., Whitehead, W.E., Pezza, V., Morelli, A., & Bassotti, G. (2006). Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology, 130, 657–664.
To assess long-term (24-month) efficacy of biofeedback versus laxatives and bowel education.
Biofeedback training was provided in five 30-minute classes over five weeks. Similarly, laxative plus bowel education was provided in five 30-minute bowel training classes over five weeks. Those patients also took 14.6 to 22.9 g/kg of polyethylene glycol for the first six months; after six months, patients took the dose BID.
Tertiary gastroenterology clinic in Verona, Italy
This was a randomized, controlled trial.
Biofeedback should be the treatment of choice for PFD-induced constipation.