Biofeedback Therapy and Pelvic Floor Physical Therapy in the Treatment of Constipation and Fecal Incontinence Are...

International guidelines recommend anorectal biofeedback therapy or pelvic floor physical therapy for the treatment of constipation and fecal incontinence (FI). However, the similarities and differences between these therapies are unclear.

This practitioner survey aimed to evaluate the practice patterns of biofeedback therapists (BTs) and pelvic floor physical therapists (PTs).

This survey was targeted at BTs and PTs in community and hospital settings.

We conducted an international online survey about training, equipment, techniques, and practice patterns of BTs and PTs in treating patients with constipation and FI, distributed through specialist societies and known contacts. Language style was adjusted to the participants' preferences.

We received 289 responses from 226 (78.2%) PTs and 63 (21.8%) BTs from Australia/New Zealand (119; 41.2%), the USA (90; 31.1%), and the rest of the world (80; 27.7%). The use of biofeedback in treating anorectal disorders often or always differed; BTs 80.4% versus PTs 51.8% (OR 4.50 (2.48-8.17)). Equipment for delivering biofeedback differed: electromyography (BTs 32.1% versus PTs 77.1%; OR 0.14 (0.07-0.27)), manometry (BTs 71.4% versus PTs 4.8%; OR 45.94 (18.35-115.02)), and ultrasound (BTs 0% versus PTs 50.3%). Ancillary device use differed (e.g., footstool (BTs 68.8% versus PTs 88.7%; OR 0.32 (0.18-0.55)), release device (BTs 6.5% versus PTs 27.9%; OR 0.06 (0.03-0.13)), trigger point (BTs 4.9% versus PTs 28.9%; OR 0.04 (0.02-0.11))). Techniques used differed: abdominal massage (BTs 31.1% versus PTs 59.6%; OR 0.27 (0.15-0.46)), balloon expulsion BTs 65.6% versus PTs 9.4% (OR 14.82 (7.95-27.65)).

The uneven distribution of respondents between countries and groups and reliance on self-reporting limits the generalizability of this exploratory study.

BTs and PTs reported vast differences in the delivery of care for anorectal disorders. PTs use biofeedback less often and, when delivering biofeedback, use less manometry and more electromyography and ultrasound. Recognition of these differences may better inform referring providers and facilitate a more collaborative, standardized approach in the future.