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Outcome of Biofeedback Therapy in Dyssynergic Defecation Patients With and Without Irritable Bowel Syndrome

Patcharatrakul, Tanisa MD; Gonlachanvit, Sutep MD

Journal of Clinical Gastroenterology: August 2011 - Volume 45 - Issue 7 - p 593–598
doi: 10.1097/MCG.0b013e31820c6001
ALIMENTARY TRACT: Original Articles

Aim The Rome II and III diagnostic criteria for dyssynergic defecation require the exclusion of irritable bowel syndrome (IBS). To prospectively study whether the presence of IBS affects the outcome of biofeedback therapy in dyssynergic defecation patients.

Methods Consecutive patients with dyssynergic defecation underwent biofeedback therapy. Dyssynergic defecation was diagnosed based on symptoms, anorectal manometries, balloon expulsion tests, and colonic transit studies. The defecation dynamics and balloon expulsion time were evaluated at the end of the biofeedback therapy in all patients. IBS symptoms were graded before and 4 weeks after the biofeedback therapy using a 4-point Likert scale. Failure of the biofeedback therapy was defined as <50% improvement of constipation symptoms, which were evaluated using a 10 cm long visual analog scale before and 4 weeks after biofeedback therapy.

Results Fifty patients completed the study. The biofeedback therapy was successful in 30 patients. Twenty-nine patients fulfilled the Rome II criteria for IBS. Patients with or without IBS demonstrated similar responses to the biofeedback therapy (16 of 29 vs. 14 of 21, P>0.05). The disappearance of IBS symptoms was observed more frequently in patients with an improved defecation index compared with those with no improvement (8 of 12 vs 4 of 17, P<0.05). A high pretreatment constipation symptom score, a high rectal sensory threshold, and a delayed colonic transit time were associated with a poor treatment outcome.

Conclusions The presence of IBS in dyssynergic defecation did not affect the outcome of biofeedback therapy. In addition, treating dyssynergic defecation patients with IBS by biofeedback therapy improved both constipation and IBS symptoms.

GI Motility Research Unit, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Grant Support: This study was supported by a grant from the Gastroenterology Association of Thailand and by the Ratchadapiseksompotch Fund at Chulalongkorn University (The GI Motility Research Unit grant).

Disclosures: The authors have nothing to disclose. No conflicts of interest exist.

Author Contributions: Sutep Gonlachanvit contributed to the study design, obtained funding, conducted the biofeedback therapy, and revised and provided the final approval of the manuscript. Tanisa Patcharatrakul participated in the study design, data acquisition, performed the statistical analysis, and drafted the manuscript.

Reprints: Sutep Gonlachanvit, MD, GI Motility Research Unit, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Rama 4 Road, Patumwan, Bangkok 10330, Thailand (e-mail:

Received September 6, 2010

Accepted December 20, 2010

© 2011 Lippincott Williams & Wilkins, Inc.