Electroacupuncture combined with biofeedback for obstructed defecation syndrome: a retrospective cohort study

To investigate the therapeutic efficacy of electroacupuncture combined with biofeedback therapy (BFT) in patients with obstructed defecation syndrome (ODS).

This single-center retrospective cohort study included 296 patients with ODS, who were assigned to either a BFT group (n = 112) or an electroacupuncture plus BFT group (n = 184) according to the treatment modality received. "Post-treatment" outcomes were operationally defined as assessments performed after completion of the 10th BFT session and before initiation of the 11th session. The primary outcome was the responder rate based on mean weekly complete spontaneous bowel movements (CSBMs). Secondary outcomes included the Constipation Scoring System (CSS), Traditional Chinese Medicine (TCM) syndrome score for constipation, quality of life assessed by the Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL), and pelvic floor surface electromyography (sEMG) parameters. Clinical efficacy grade was determined according to the TCM syndrome therapeutic efficacy evaluation criteria.

Baseline characteristics were comparable between the two groups (P > 0.05). The overall response rate was significantly higher in the electroacupuncture plus BFT group than in the BFT group (90.76% [167/184] vs. 80.36% [90/112], P < 0.05). Weekly CSBM responder rate was also significantly higher in the combination group (90.8% vs. 69.6%, P < 0.05). After treatment, both groups showed significant improvements in mean weekly CSBM per patient, mean weekly laxative use days, CSS scores, TCM syndrome score for constipation, PAC-QOL scores, and pelvic floor sEMG parameters compared with baseline (all P < 0.01). Improvements in TCM syndrome score for constipation, the coefficient of variation of the pre-resting baseline, post-rapid contraction relaxation time, and endurance contraction coefficient of variation were significantly greater in the combination group than in the BFT group (P < 0.05). Female patients showed smaller improvement in PAC-QOL scores than male patients (β = 4.403, P = 0.004). In the multivariable ordinal model, treatment modality was associated with higher efficacy grades, whereas laxative use during the treatment period was associated with lower efficacy grades (both P < 0.001). In addition, disease duration was positively correlated with improvements in CSS scores.

Electroacupuncture combined with BFT is more effective than BFT alone in alleviating defecatory difficulty and improving quality of life in patients with ODS, suggesting that this combined approach has favorable clinical applicability.