Biofeedback therapy for defecatory dysfunction: "Real life" experience

Daniela Jodorkovsky, Kerry B. Dunbar, Susan L. Gearhart, Ellen M. Stein, John O. Clarke

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Biofeedback therapy (BF) is a well-established treatment modality for patients with dyssynergic defecation and fecal incontinence (FI). Randomized controlled trials from highly specialized tertiary care centers report response rates of 70% to 80% for dyssynergic defecation and 55% to 75% for FI. Whether this therapy is as successful outside of clinical trials or specialized biofeedback referral centers remains unclear. AIM: Our primary aim was to determine what percentage of patients referred for BF actually complete therapy and identify barriers to treatment. Our secondary aim was to determine the clinical response rate in a heterogenous population of patients undergoing BF at our institution and a variety of regional locations. METHODS: We retrospectively reviewed patients who underwent high resolution anorectal manometry between 2007 and 2010 for symptoms of defecatory dysfunction. BF was recommended at the time of manometry analysis based on findings of dyssynergy, impaired or heightened rectal sensation, or poor augmentation of sphincter on squeeze maneuvers. Clinical response was recorded after a course of BF (≥5 sessions). RESULTS: Two hundred three patients (78% female, 72% white; median age 52) underwent anorectal manometry for symptoms of constipation (130), FI (54), combination (12), and rectal pain (7). BF was recommended in 119 cases (58.6%): constipation (80), FI (27), combination (9), and rectal pain (3). Only 39 out of 80 (48%) patients with constipation ultimately underwent BF. Of the 27 FI cases, only 12 (44%) patients underwent BF. Barriers to BF included lack of insurance coverage, distance to local treatment facilities, and acute medical issues taking precedence. Of those who underwent at least 5 BF sessions, subjective short-term response rates based on patient opinion were 17/28 (60%) in the constipation group and 8/10 (80%) in the FI group. Age, sex, and race had no effect on whether the patients attended biofeedback or whether they responded to treatment. The location of BF also did not predict response to therapy. CONCLUSIONS: In a heterogenous patient population, less than half of patients recommended for BF ultimately underwent therapy. Despite this, the response rates in this small population undergoing BF in the "real world" are only slightly less than published randomized control trials. Prospective studies are warranted to further elucidate and eliminate barriers to BF, especially given that "real world" BF response rates may be comparable with those seen in clinical trials.

Original languageEnglish (US)
Pages (from-to)252-255
Number of pages4
JournalJournal of Clinical Gastroenterology
Volume47
Issue number3
DOIs
StatePublished - Mar 2013

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Life Change Events
Fecal Incontinence
Therapeutics
Constipation
Biofeedback (Psychology)
Manometry
Defecation
Clinical Trials
Population
Pain

Keywords

  • anorectal manometry
  • biofeedback
  • constipation
  • dyssynergy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Biofeedback therapy for defecatory dysfunction : "Real life" experience. / Jodorkovsky, Daniela; Dunbar, Kerry B.; Gearhart, Susan L.; Stein, Ellen M.; Clarke, John O.

In: Journal of Clinical Gastroenterology, Vol. 47, No. 3, 03.2013, p. 252-255.

Research output: Contribution to journalArticle

Jodorkovsky, Daniela ; Dunbar, Kerry B. ; Gearhart, Susan L. ; Stein, Ellen M. ; Clarke, John O. / Biofeedback therapy for defecatory dysfunction : "Real life" experience. In: Journal of Clinical Gastroenterology. 2013 ; Vol. 47, No. 3. pp. 252-255.
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abstract = "BACKGROUND: Biofeedback therapy (BF) is a well-established treatment modality for patients with dyssynergic defecation and fecal incontinence (FI). Randomized controlled trials from highly specialized tertiary care centers report response rates of 70{\%} to 80{\%} for dyssynergic defecation and 55{\%} to 75{\%} for FI. Whether this therapy is as successful outside of clinical trials or specialized biofeedback referral centers remains unclear. AIM: Our primary aim was to determine what percentage of patients referred for BF actually complete therapy and identify barriers to treatment. Our secondary aim was to determine the clinical response rate in a heterogenous population of patients undergoing BF at our institution and a variety of regional locations. METHODS: We retrospectively reviewed patients who underwent high resolution anorectal manometry between 2007 and 2010 for symptoms of defecatory dysfunction. BF was recommended at the time of manometry analysis based on findings of dyssynergy, impaired or heightened rectal sensation, or poor augmentation of sphincter on squeeze maneuvers. Clinical response was recorded after a course of BF (≥5 sessions). RESULTS: Two hundred three patients (78{\%} female, 72{\%} white; median age 52) underwent anorectal manometry for symptoms of constipation (130), FI (54), combination (12), and rectal pain (7). BF was recommended in 119 cases (58.6{\%}): constipation (80), FI (27), combination (9), and rectal pain (3). Only 39 out of 80 (48{\%}) patients with constipation ultimately underwent BF. Of the 27 FI cases, only 12 (44{\%}) patients underwent BF. Barriers to BF included lack of insurance coverage, distance to local treatment facilities, and acute medical issues taking precedence. Of those who underwent at least 5 BF sessions, subjective short-term response rates based on patient opinion were 17/28 (60{\%}) in the constipation group and 8/10 (80{\%}) in the FI group. Age, sex, and race had no effect on whether the patients attended biofeedback or whether they responded to treatment. The location of BF also did not predict response to therapy. CONCLUSIONS: In a heterogenous patient population, less than half of patients recommended for BF ultimately underwent therapy. Despite this, the response rates in this small population undergoing BF in the {"}real world{"} are only slightly less than published randomized control trials. Prospective studies are warranted to further elucidate and eliminate barriers to BF, especially given that {"}real world{"} BF response rates may be comparable with those seen in clinical trials.",
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