Biofeedback
For a select group of patients
Almost all current forms of constipation treatments involve the use of laxatives and fiber supplements that stimulate changes in the chemical balance of the gut to bring about constipation relief. Many patients may feel that such treatments are temporary solutions, as it requires continual administration of such treatments.
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Patients may also feel that treatments which rely on medication are unsatisfactory and would prefer an alternative or natural method for relieving constipation. For a select group of patients this may be a possibility soon.
Pelvic floor dyssynergia
Pelvic Floor Dyssynergia refers to a collection of conditions involving the muscles below the pelvic region which are involved in contraction and relaxation during bowel movements as stool exits the rectum and anus. In some patients, these muscles become damaged and do not move in a coordinated fashion or are unable to relax. Patients often feel they cannot empty their stool completely, need to strain hard, or require some manual intervention to evacuate completely.
The condition can be assessed by diagnostics that measure the muscle strength and pressure in the rectum. Treatment with high fiber therapy does help about one third of such patients, but as this is ultimately a disorder of the muscles, it should be no surprise that the majority do not benefit from high fiber treatment. But in recent years, a new method called biofeedback has been under development for such patients. A scientific trial was conducted successfully to show that patients with pelvic floor dyssynergia benefit from biofeedback therapy.
The principle of rehabilitation therapy
What is biofeedback? Biofeedback is one of the constipation remedies that work off the same principle as rehabilitation therapy. Steady, directed muscle movements combined with observation of results leads to continued improvement. However patients cannot usually see their pelvic muslces in action, nor can they assess easily how well they are passing stool. To remedy this, researchers have devised a pelvic floor rehabilitation technique by hooking up the rectal region to an electromyogram, which can measure the activity of muscles in the rectal region and display it on a monitor. Watching this specific measure of muscle activity, patients contract and relax muscles to try to expel an air-filled balloon.
Scientific studies
In the study, 55 patients with dyssynergia were put on biofeedback therapy, and another 55 were put on standard laxative therapy. At the end of 5 weeks, it was found that 80% of the biofeedback patients expereinced major improvement, whereas only 22% of those in the laxative group show major improvement. Although stool frequency increased in both populations.
Requires time
By its nature, biofeedback is a slow process requiring lots of practice and patience from those who are engaging in it. It is also a nonstandard therapy and may require more effort from the patient to figure out the costs and logistsics of enrolling in such a program. But patients with pelvic floor dyssynergia should consider this treatment option, as such patients are less likely to find standard constipation treatments working well due to the muscle-related nature of the disorder.
Sources
Chiarioni et al, Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia, Gastroenterology, 2006;130:657-664