Biofeedback: its role in the treatment of chronic constipation.

Constipation accounts for more than 2.5 million physician visits a year. Treatment of constipation has been a long-standing and costly problem. Affecting approximately 4.5 million Americans, predominantly women and the elderly, constipation can be persistent and difficult to manage. With the great number of laxative products available, more than $350 to $400 million is spent on over-the-counter laxatives each year. In addition to a complete history and physical examination, tests of anorectal function are useful in the assessment of defecation disorders. Approximately 50% of patients exhibit uncoordinated or dyssynergic defecation patterns. Biofeedback therapy may improve the symptoms of these patients. Biofeedback therapy is labor-intensive, expensive, and available only at a few centers. Although the concept of dyssynergic defecation has existed for only a few years, its therapy, based on neuromuscular conditioning, is gaining recognition. The biofeedback program from one Midwestern tertiary care center is described. Although much still needs to be learned regarding the etiology and pathophysiology of dyssynergic defecation, its management with biofeedback is shown to be efficacious and may prove to be the treatment of choice for patients with this dysfunction of the pelvic floor.