Biofeedback therapy for outlet dysfunction: our experience.

Biofeedback is an important therapeutic option in patients with outlet dysfunction. A total of 75 patients referred to our proctological division from March 2004 to June 2008 and complaining of chronic constipation were studied by history, physical examination, anorectal functional tests and a structured questionnaire. Patients were treated with biofeedback plus electrical stimulation or both biofeedback plus electrical stimulation and surgery. Sixty of the 75 patients were treated with biofeedback only; and 15 with both treatments. All patients underwent, on average, twice weekly 15-minute EMG-biofeedback training sessions followed by 5 minutes of electrical stimulation. At 6 months' follow-up all physiological parameters with the exception of anal squeeze pressure showed a significant improvement (p < 0.05); there were reductions in sensation of incomplete evacuation (from 72 to 29.3 percent), in difficult stool passage (from 76 to 18.7 percent), and in the use of laxatives, enemas or digital manoeuvres (from 88 to 40 percent). At a telephone follow-up at 1 year, an improvement in satisfaction was reported by 77.3% of patients (58/75). The results of this study confirm that biofeedback plus electrical stimulation produces an improvement in bowel symptoms in patients with outlet dysfunction, as well as underlining the importance of anorectal functional tests as a guide to the most appropriate treatment.