April 5, 2006

Biofeedback best for common type of constipation

By Megan Rauscher

NEW YORK (Reuters Health) - Study findings indicate that
biofeedback is far more effective than laxatives in relieving
constipation caused by inappropriate contraction or inability
to relax the pelvic floor muscles during defecation -- what
doctors call "pelvic floor dyssynergia."

"Biofeedback should become the treatment of choice for this
common and easily diagnosed type of constipation," the
investigators conclude.

In a randomized, controlled trial, Dr. Giuseppe Chiarioni
from the University of Verona in Italy and an international
team compared the effects of five weekly 30-minute biofeedback
sessions with one of the most effective laxatives (polyethylene
glycol) plus constipation prevention counseling.

Biofeedback training included teaching subjects to strain
more effectively, to coordinate expulsion efforts with their
breathing and to relax pelvic floor muscles.

The study involved 109 patients (all but five of whom were
women) with constipation due to chronic severe pelvic floor
dyssynergia who had failed attempts to relieve constipation
with 20 grams per day of fiber plus enemas or suppositories up
to twice weekly.

Biofeedback, Chiarioni told Reuters Health, proved "highly
effective in determining a long lasting improvement in
constipation symptoms and anorectal function in the majority of
patients. Continuous laxatives, on the other hand, were
marginally effective in a minority of patients."

Specifically, at 6 months 80 percent of the biofeedback
group had "major improvement" in constipation compared with
just 22 percent of the laxative group. The benefits of
biofeedback were still evident at 2 years, the team reports.

Compared with laxatives, biofeedback produced greater
reductions in straining, sensations of incomplete evacuation,
and blockage, use of enemas and suppositories and abnormal
pain, according to a report of the study in Gastroenterology.
Stool frequency increased in both treatment arms.

Pelvic floor dyssynergia is one of the most disabling
subtypes of constipation. "Our findings should prompt
physicians to search for this common subtype of functional
constipation to avoid treating affected patients with a poorly
effective therapy (laxatives)," Dr. Chiarioni told Reuters

SOURCE: Gastroenterology March 2006.