Abstract
Aim To evaluate the short-term efficacy of biofeedback therapy (BFT) for dyssynergic defecation (DD) and to explore the predictors of the efficacy of BFT. Methods Clinical symptoms, psychological state, and quality of life of patients before and after BFT were investigated. All patients underwent lifestyle survey and anorectal physiology tests before BFT. Improvement in symptom scores was considered proof of clinical efficacy of BFT. Thirty-eight factors that could influence the efficacy of BFT were studied. Univariate and multivariate analysis was conducted to identify the independent predictors. Results Clinical symptoms, psychological state, and quality of life of DD patients improved significantly after BFT. Univariate analysis showed that efficacy of BFT was positively correlated to one of the 36-item Short-Form Health Survey terms, the physical role function (r = 0.289; P = 0.025), and negatively correlated to the stool consistency (r = −0.220; P = 0.032), the depression scores (r = −0.333; P = 0.010), and the first rectal sensory threshold volume (r = −0.297; P = 0.022). Multivariate analysis showed depression score (β = −0.271; P = 0.032) and first rectal sensory threshold volume (β = −0.325; P = 0.013) to be independent predictors of BFT efficacy. Conclusion BFT improves the clinical symptoms of DD patients. Depression state and elevated first rectal sensory threshold volume were independent predictors of poor outcome with BFT.
Highlights
Chronic constipation (CC) is diagnosed when there is at least a 6-month history of symptoms such as infrequent bowel movement, reduced stool volume, hard stools, and excessive straining at defecation [1]
We evaluated the efficacy of biofeedback therapy (BFT) in dyssynergic defecation (DD) and attempted to identify the factors that could predict the success of BFT
We found that BFT could improve the clinical symptoms of patients with DD
Summary
Chronic constipation (CC) is diagnosed when there is at least a 6-month history of symptoms such as infrequent bowel movement, reduced stool volume, hard stools, and excessive straining at defecation [1]. The median prevalence is 16% in the US and is as high as 33.5% in adults aged 60–101 years [2]. The overall prevalence in Chinese adults is 16%–20% [3]. Primary constipation consists of several overlapping subtypes, among which dyssynergic defecation (DD) is relatively common [4, 5]. Patients with DD have symptoms of obstructive defecation, such as severe straining during defecation and a sensation of a “blockage” and of incomplete evacuation. Pharmacological therapies that are usually effective in CC, such as bulking agents, osmotic laxatives, stimulant laxatives, and stool softeners [8], are often ineffective in DD patients [9]
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