Biofeedback therapy in fecal incontinence and constipation

Area of Science:

• Pelvic floor dysfunction
• Gastroenterology
• Rehabilitation medicine

Background:

• Biofeedback therapy (BFT) is utilized for conditions like incontinence and constipation.
• Randomized controlled trials (RCTs) are crucial for evaluating therapeutic efficacy.
• Meta-analysis provides a quantitative synthesis of evidence from multiple studies.

Purpose of the Study:

• To meta-analyze RCTs assessing the efficacy of biofeedback therapy (BFT) for constipation and incontinence.
• To compare different modes of BFT against non-BFT interventions and against each other.

Main Methods:

• Systematic PubMed search for randomized controlled trials meeting quality criteria.
• Meta-analyses using fixed effect models to calculate odds ratios (OR) and 95% confidence intervals (CI).
• Comparison of electromyographic (EMG) BFT versus non-BFT and other BFT modes for constipation.
• Comparison of BFT versus non-BFT and different BFT modalities for fecal incontinence.

Main Results:

• For constipation, BFT demonstrated superiority over non-BFT treatments (OR: 3.657; P < 0.001).
• No significant difference was found between EMG BFT and other BFT modes for constipation (OR: 1.436; P = 0.319).
• For fecal incontinence, BFT showed no significant difference compared to non-BFT therapies (OR: 1.189; P = 0.535) or other BFT modes (OR: 1.278; P = 0.384).
• Included trials exhibited considerable heterogeneity in quality, endpoints, and psychological assessments.

Conclusions:

• Biofeedback therapy for pelvic floor dyssynergia demonstrates a specific therapeutic effect.
• Current evidence for the efficacy of BFT in treating incontinence remains limited.
• The specific mode of BFT appears to play a minor role in therapeutic outcomes for both conditions.