Clinical and Physiological Effects of Biofeedback in Outlet Obstruction Constipation
Yik-Hong Ho, F.R.A.N.C.S., F.A.M.S., Margaret Tan, A.N., Hak-Su Goh, F.R.C.S.,
F.A.M.S.
From the Department of Colorectal Surgery, Singapore General Hospital, Singapore,
Singapore
PURPOSE:We report the results of biofeedback (BF) on patients with outlet obstruction
defecation (OOC), including those with and without measurable paradoxical puborectalis
contractions (PP). Clinical and anorectal physiologic parameters (ARP) were assessed one week
before and after a standardized course of BF.
METHODS:Sixty-two consecutive
patients (24 men, 38 woman; mean age, 48 (standard error of the mean, 2.3)years) were
recruited. All had persistent constipation despite six weeks of dietary fiber supplements. Colonic
inertia was excluded by transit marker studies. Defecating proctography excluded anatomic
abnormalities causing outlet obstruction. Patients underwent four outpatient sessions of
biofeedback, each session lasting one hour.
RESULTS:After BF, 56 patients (90.3
percent) were subjectively improved. Frequency of spontaneous bowel movements were
significantly increased (P = 0.003). Frequency of laxative induced (P = 0.004) and enema-induced (P = 0.005) stools were reduced. Anal resting (P = 0.04) and squeeze (P = 0.002)
pressures were increased. Number of patients with PP was reduced from 40 to 31 (P = 0.004).
Presence of PP did not affect response to BF. There were no differences in ARP between the 56
patients who improved and the 6 who did not. There were no side effects or clinical regressions
after a mean follow-up of 14.9 (standard error of the means, 0.9) months.
CONCLUSIONS:BF effectively treated OOC in 90.3 percent, regardless of PP. Anal
pressures were increased, and PP was decreased. [Key words: Biofeedback; Constipation;
Manometry; Puborectalis paradoxus]
Ho Y-H, Tan M, Goh H-S. Clinical and physiologic effects of biofeedback in outlet obstruction
constipation. Dis Colon Rectum 1996;39:520-524.
Biofeedback Therapy for Excessive Stool Frequency and Incontinence Following Anterior
Resection or Total Colectomy
Yik-Hong Ho, F.R.A.C.S.,* Jy-Ming Chiang, M.D., Margaret Tan, A.N., Joyce Yee Low,
M.B.B.S.*
From the Department of Colorectal Surgery, Singapore General Hospital, Singapore, and the
Colorectal Surgery Section, Chang Gung Memorial Hospital, Taipei, Taiwan
PURPOSE:Excessive stool frequency and incontinence after anterior resection (AR) or
total colectomy (TC) can be refractory to expectancy and antidiarrheal agents. We prospectively
assessed efficacy of anorectal biofeedback therapy (BF) in this clinical situation.
METHODS:Thirteen patients (10 men and 3 woman; mean age, 62.1 (standard error of
the mean (SEM), 4.6) years) had more than six bowel movements per day and/or episodes of
incontinence, which did not abate after antidiarrheal agents were given for at least six (mean, 27.9
(SEM, 6.3)) months after surgery. All underwent four sessions of outpatient BF. Assessment
was by continence questionnaire and anorectal physiology tests, which were administered before
and after BF.
RESULTS:In seven AR patents, daily stool frequency was decreased (8.7
(SEM, 2.1) before and 4.6 (SEM, 1.2) after; P<0.05), and daily incontinence episodes were
reduced (2.7 (SEM, 0.9) before and 0.4 (SEM, 0.2) after P< 0.05) after BF. Six TC patients also
had decreased daily stool frequency (6.2 (SEM, 2.1) before, 3.3 (SEM, 1.6) after; P < 0.05) and
incontinence episodes (2.4 (SEM, 0.9) before, 0.5 (SEM, 1) after; P< 0.05) after BF. There were
no significant changes in anorectal physiology parameters after BF. At a mean follow-up of 10.6
(SEM, 2.5) months after BF, there were no regressions or complications.
CONCLUSIONS:BF is a safe and effective option for refractory excessive stool
frequency and/or incontinence following AR or TC. [Key words: Biofeedback; Colon;
Continence; Rectum; Surgery]
Ho-Y-H, Chiang J-M, Tan M, Low JY. Biofeedback therapy for excessive stool frequency and
incontinence following anterior resection or total colectomy. Dis Colon Rectum 1996;39:1289-1292.
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