Biofeedback training versus botox injection for the treatment of dyssynergic defaecation: A randomized controlled...

Dyssynergic defaecation (DD) is a condition characterized by impaired relaxation or paradoxical contraction of the puborectalis muscle and external anal sphincter during defaecation. This dysfunction leads to chronic constipation and obstructed defaecation, significantly impacting quality of life. The aim of this work was to compare biofeedback (BFB) training and botulinum toxin type-A (BTX-A) injection in the management of DD.

This a randomized, controlled, intervention including 78 patients complaining of DD. The patients were classified into two categories each comprising 39 participants: Group I (BFB training group) underwent six sessions of BFB over one and half months of retraining and Group II (BTX-A injection group) underwent three-dimensional endoluminal ultrasound-guided BTX-A injection at the Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt from August 2023 to August 2024.

A statistically significant difference was observed between before and after BTX-A injection regarding the presence of anal fissure. There was a significant relation between history of vaginal delivery and change in maximum resting pressure (p = 0.02) and in maximum tolerable volume (p = 0.03). In contrast, no relation was observed with the changes in maximum squeeze pressure, rectal sensation and desire to defaecate. There was no statistically significant difference between the two groups with regard to the preintervention Wexner Constipation Score (WCS). On the other hand, there were significant differences at 2 weeks (p = 0.006), 1 month (p = 0.009) and 3 months (p = 0.01) postintervention in favour of the BFB group.

Both groups were effective in managing DD; however, BFB demonstrated greater short-term improvement in WCS while BTX-A significantly improved anorectal physiology, as evidenced by anorectal manometry.