Biofeedback can help ease chronic constipation

Chronic constipation affects 15 to 20 percent of the US population. Nearly one third of sufferers have dissynergic defecation, in which the muscles used for bowel movements do not work well. However, biofeedback treatment has already been in use to train these muscles for some time now.

Many people with dissynergenic defecation have life-long constipation and experience significant difficulty with passing stools – yet they have no idea they are suffering from this form of chronic constipation, says Satish Rao, MD, Professor of Internal Medicine at the University of Iowa Roy J. and Lucille A. Carver College of Medicine.

A few years ago, the University of Iowa did a study to show biofeedback treatment can successfully retrain muscles, and that it was better than the standard combination of laxatives, diet and exercise, or other procedures involving muscular relaxation and coping strategies. Their findings appeared in the March 2007 issue of the journal Clinical Gastroenterology and Hepatology. 

Biofeedback technique improves body awareness

The biofeedback technique involves making people more aware of the unconscious or involuntary bodily functions involved in defecation. The technique includes placing a pencil-thin probe into the rectum to provide feedback information about how the body muscles are performing. This data, as well as visual and verbal feedback techniques, help individuals relearn the normal process of having a bowel movement. 

The UI study included 79 adults with an average age of 43 who had dyssynergenic defecation. The 69 female and eight male participants were randomly assigned to one of three study groups: standard, biofeedback or “sham” biofeedback. In the biofeedback group, 79 percent of the individuals corrected their bowel function during the study. In contrast, only four percent of the sham group and slightly more than eight percent of the standard group showed corrected muscular function.

“We showed the biofeedback group how to improve their pushing effort and relax the pelvic floor and anal sphincter muscles so that they could ‘poop’ normally and easily. The probe gives us information about how the muscles are working,” says Rao.

“Many people with dyssynergic defecation have lifelong constipation and they experience significant difficulty passing stools; but they are unaware that they have this particular type of chronic constipation,” says Dr Mark Wong, Consultant, Department of Colorectal Surgery at Singapore General Hospital (SGH). “Biofeedback therapy has been available since the 1990s, but a lack of awareness has resulted in its underutilization”.

Prevalence in Singapore

Most Singaporeans with constipation problems are treated at SGH’s Pelvic Floor Disorder Clinic. Up to 25 percent of them are 40 or younger. The majority of constipation sufferers are likely to just live with the condition and feel content to rely on laxatives, mainly due to lack of understanding about their problem. It can be due to weakness or deficiency of the pelvic floor muscles, and it can affect people as young as teenagers. Women are more prone to the condition, as their pelvic floor supports more organs and so it can weaken easily, particularly after childbirth and menopause.

Other common causes of constipation are taking too little or too much fibre; lack of exercise; stress; pregnancy; medical conditions such as stroke, depression, eating disorders and colon cancer; and the side effects of medication like antidepressant pills and iron pills.

Further links:
Sgh.com.sg
Sciencedaily.com