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Simple electromyographic biofeedback treatment for chronic pediatric constipation/encopresis: preliminary report
D J Cox1, J Sutphen, S Borowitz
1Behavioral Medicine Center, Blue Ridge Hospital, University of Virginia Health Sciences Center, Charlottesville 22901.
Insights
Biofeedback therapy effectively eliminated paradoxical external anal sphincter (EAS) contractions in children with chronic constipation. This led to significant improvements in bowel function and reduced reliance on laxatives compared to standard care alone.
Area of Science:
- Pediatric Gastroenterology
- Pelvic Floor Physical Therapy
- Biofeedback Therapy
Background:
- Pediatric constipation and encopresis are often linked to paradoxical external anal sphincter (EAS) muscle contraction during defecation attempts.
- This inappropriate EAS contraction results in delayed, impacted, painful, and infrequent bowel movements, significantly impacting a child's quality of life.
- Standard Medical Care (SMC) typically includes disimpaction, laxatives, and dietary changes to manage symptoms.
Purpose of the Study:
- To compare the efficacy of Standard Medical Care (SMC) alone versus SMC combined with external anal sphincter (EAS) electromyographic biofeedback.
- To determine if biofeedback can eliminate paradoxical EAS contraction in children with chronic constipation.
- To assess long-term improvements in constipation, encopresis, laxative use, and painful bowel movements.
Main Methods:
- A case-control study design was employed.
- Thirteen chronically constipated children received SMC plus EAS electromyographic biofeedback.
- These subjects were compared to 13 age- and sex-matched controls receiving only SMC.
Main Results:
- Children who received biofeedback demonstrated the elimination of EAS paradoxical constriction post-treatment.
- At a 16-month follow-up, parents of children in the biofeedback group reported significantly greater improvements.
- Improvements were noted in constipation, encopresis, reduced laxative use, and fewer painful bowel movements compared to the SMC-only group.
Conclusions:
- EAS electromyographic biofeedback is an effective adjunct to Standard Medical Care for pediatric constipation and encopresis.
- Biofeedback therapy successfully addresses the underlying physiological dysfunction of paradoxical EAS contraction.
- This approach offers significant, sustained benefits for children suffering from chronic constipation and related issues.
Abstract:
Pediatric constipation/encopresis is thought to be due, in part, to paradoxical constriction of the external anal sphincter (EAS) muscle during attempted defecation. This inappropriate contraction can lead to delayed, impacted, painful, and infrequent bowel movements. Standard Medical Care (SMC) involves disimpaction with enemas, followed by laxative therapy and diet modification, to maintain frequent soft stools. Using the case control method, the efficacy of SMC alone was compared with SMC plus EAS electromyographic biofeedback aimed at eliminating paradoxical contraction. Thirteen consecutive chronically constipated children received SMC plus biofeedback, and were compared with 13 age- and sex-matched children who received only SMC. Biofeedback subjects demonstrated post-treatment elimination of EAS paradoxical constriction. At 16 months follow-up parents of biofeedback children reported significantly greater improvement in constipation, encopresis, laxative use, and painful bowel movements compared to SMC.