Biofeedback treatment of chronic constipation: myths and misconceptions

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Rehabilitation

Background:

• Chronic constipation affects many, impacting healthcare costs and quality of life.
• Refractory constipation cases often require specialized evaluation, identifying subtypes like slow transit or functional defecation disorders.
• Functional defecation disorders are linked to maladaptive behaviors, with biofeedback therapy as a key treatment.

Purpose of the Study:

• To review and address non-evidence-based beliefs regarding biofeedback therapy for constipation.
• To clarify protocols, efficacy, indications, and safety of biofeedback.
• To emphasize identifying ideal candidates with functional defecation disorders for biofeedback retraining.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) on biofeedback therapy for constipation.
• Analysis of evidence concerning biofeedback protocols, effectiveness, and safety.
• Focus on patient selection criteria for functional defecation disorders.

Main Results:

• RCTs confirm biofeedback therapy's effectiveness for severe, refractory constipation caused by functional defecation disorders.
• Biofeedback is considered a safe and minimally invasive treatment option.
• Evidence supports specific protocols and indications for optimal outcomes.

Conclusions:

• Biofeedback therapy is a safe and effective treatment for functional defecation disorders, a subtype of refractory constipation.
• Identifying appropriate candidates is crucial for successful biofeedback retraining.
• Despite limitations, biofeedback remains the safest approach for this challenging condition.