Home versus office biofeedback therapy for dyssynergic defecation: parallel arm (RCT)
Dyssynergic is a subtype of primary chronic constipation characterized by difficulty stool propulsion, inadequate anal relaxation and paradoxical anal contraction.
As Biofeedback has shown to be effective with patients with dyssenergic dysfunction and has positive impact on symptoms, as it provides visual, auditory stimulus during session to motivate patient and gives him a feedback about his performance during sessions.One of disadvantages it's costly expensive intervention.
purpose of the study
The aim of this study to compare if home biofeedback is efficacious as office biofeedback
The sample of study has included adult outpatients (18-80 years), had dyssynergic pattern of defecation and failed normal routine management of constipation.
Exclusions criteria, metabolic disease that cause constipation, neurological disease, SCI, sever cardiac and renal disease, pregnancy, anal fissure.
Patients assessed before and after treatment for slow colonic transit movement by a prospective stool diary.
Before treatment they were advised with diet rich in fibers and fluid intake. They have learned diaphragmatic breathing techniques to use them in session during training. And to attempt bowel movement 5 min twice daily, 30 min after eating.
Office biofeedback (OB)
Office device has used data record and software, session applied on three stages:
1-Patient instructed to diaphragmatic breathing
2-Patient used diaphragmatic breathing to increase intra-abdominal intra- rectal pressure that increase push effort that’s in turn improves recto-anal coordination while seated on commode and receiving visual, verbal feedback.
3-Patients trained to expel 50ml artificial stool.
Applied 1h session to maximum 6 session /3 months
Home biofeedback (HB)
Home training device consists of a hand held device gives feedback about patients performance.
Before the start, patients have learned how to place the probe into their rectum.
Patient seated on commode and attempt 10-15 push while observing hand held device.
Applied 2 sessions/day each session 20 min. Patient returns to follow up visit at 4th, 8th week.
The study used subjective and physiologic measures to measure bowel function. Subjective measure include; number of complete spontaneous bowel movement (CSBM) straining effort,stool frequency and consistency. Physiologic measure include; presence of dyssynergic pattern during defecation, anal residual pressure and intra rectal residual pressure.
The study found that biofeedback improved overall subjective outcome measures in both groups.There was significant improvement in patients who received HB (68% responders) they had greater number of CSMB, dyssynergic defecation pattern was corrected and they were satisfied about their bowel function when compared to their baseline and these result were similar to patients who received OB (70% responders). There was also improvement in anorectal and anal function.
Home biofeedback device was very well tolerated with no adverse events.
- Rao SS, Valestin JJ, Xiang X, Hamdy SS, Bradley CS, Zimmerman BM. HOME VERSUS OFFICE BIOFEEDBACK THERAPY FOR DYSSYNERGIC DEFECATION: PARALLEL ARM RANDOMIZED CONTROLLED TRIAL. The lancet. Gastroenterology & hepatology. 2018 Nov;3(11):768.