Home Biofeedback Therapy Is An Effective Option Against Constipation Difficult To Treat – ScienceDaily

Standard treatments such as diet, stool softening, or even laxatives, tend to be ineffective in patients with this type of constipation called dyssynergistic defecation, says Dr. Satish SC Rao, director of the Neuro Research Center. -Gastroenterological / Health, Digestive Health Center, Medical College of Georgia, University of Augusta.

About 15% of the US population suffers from chronic constipation and about one third of these people suffer from dyssynergic defecation.

The familiar remedies do not address the underlying problem of these patients, which is to regain the natural rhythm of contracting the muscles located above the rectum to move the stool while relaxing the muscles at the anal opening to allow stool out, explains Rao, J. Harold Harrison, MD. University Chair in Gastroenterology.

Rao led the development of an office-based biofeedback therapy, which has been proven to help these patients better recognize and improve uncoordinated muscle movement. The American Gastroenterology Association, the American Neurogastroenterology and Motility Society and the European Society of Neurogastroenterology and Motility have all approved the treatment.

However, the limited training sites and the fact that many patients had to travel long distances several times to get there, were they also intended to make the effective approach more widely available and, hopefully, the, more profitable.

The home system that they have developed seems to be just as effective, safe and less expensive, they reported in the newspaper. The lancet.

"When healthy people try to poop, we increase the intra-abdominal and intrarectal pressures while releasing anal opening.We generally learn this when we are trained to cleanliness so we do not have to." Unfortunately, patients with dyssynergia do not have this tendency, and when these patients try to abstain without their knowledge, they repel it or keep it, "says Rao, the corresponding author of study.

He notes that some have had problems since childhood, others have developed problems in adulthood due to various factors such as back surgery or hemorrhoids, even pregnancy or l & # 39; hysterectomy.

"They started making efforts and gradually changed their normal behavior to adopt this abnormal behavior.The essence of biofeedback is to convert patients with these patterns into a natural and effective regimen."

The study funded by the National Institutes of Health covered a total of 100 patients, half of whom were in each group from January 2005 to January 2010. Of the 50 patients who started in each arm, a correction of the problem was made. found in 72% of cases. home therapy group and 80% of the office group.

A total of 83 patients completed the study, 76% in the home group and 90% in the office group. According to those who completed the study, home success rates were actually higher: 92% vs. 84%, respectively.

Participants in both arms reported similar rates of improvement with key metrics such as the number of complete and spontaneous bowel movements each week, investigators reported. All participants were also better able to control their bowel movements, both groups reducing the time required to expel a balloon – which gave them a poop substitution sensation – and decreased the number of unexpected balloon discharges.

"In each of the metrics we measured, the two approaches were essentially consistent," says Rao, with the exception of costs.

Total costs, including travel time and transportation costs, were about twice as high for office therapy: $ 1,082 versus $ 1,942.

For office therapy, patients had a training session with a specialist nurse followed by six one-hour sessions over a three-month period. A manometer was used to determine if they contracted at the top of the rectum and simultaneously released the bottom, or anus. The patients also learned various breathing techniques and other techniques for good coordination. They received visual and verbal commands to improve coordination when they were sitting on the dresser.

Those selected for the home therapy arm also attended a training session in one office to learn how to use a reusable probe connected to a portable pressure monitor to see if they were pushing properly in both target areas. They were asked to sit on the dresser twice a day and try 10-15 push maneuvers while watching the pressure responses. The lights increased when the anus was properly relaxed and decreased when they did not relax those muscles. A separate panel of lights would respond in the same way to reflect the contraction of the muscles at the top of the rectum.

At the beginning and at the end of the training, participants were assessed with pressure monitoring at two key points of the rectum, a balloon expulsion test and a study of the speed with which waste, digestion residues, cross the colon using radiopaque markers. The colon, six feet long and continually contracted, moves the waste from the small intestine to the rectum. "The colon is never inactive or motionless," says Rao, but is a natural stopping point in the gastrointestinal tract where liquids and other digestible residues are reabsorbed before defecation. However, when movements slow down too much, as is the case in about 60% of patients with dyssolic stools, this also contributes to constipation. While both arms of the study have seen the restoration of a healthier colon speed, the home group has seen a more significant improvement.

Both groups maintained a stool diary throughout the study and answered the following questions about tolerability and acceptance of biofeedback treatment. Although the house group said it was a bit messy, they tolerated it well. Most of the study participants stated that they would recommend biofeedback.

The fact that both approaches produce similar results and that home care is less expensive should make them the preferred choice for these patients, write the researchers.

Now that they have the necessary information, investigators need a biotech company to develop a home biofeedback system that can be widely distributed, says Rao. For the purpose of the study, Rao used a device made by a friend.