Biofeedback treatment of constipation - A critical review

被引:92
作者
Heymen, S [1 ]
Jones, KR [1 ]
Scarlett, Y [1 ]
Whitehead, WE [1 ]
机构
[1] Univ N Carolina, Dept Med, Ctr Funct Gastrointestinal & Motil Disorders, Chapel Hill, NC 27599 USA
关键词
biofeedback; constipation; outlet obstruction; pelvic floor dyssynergia; electromyography; manometry;
D O I
10.1007/s10350-004-6717-8
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
PURPOSE: This review was designed to 1) critically examine the research design used in investigations of biofeedback for pelvic floor dyssynergia, 2) compare the various biofeedback treatment protocols for pelvic floor dyssynergia-type constipation used in this research, 3) identify factors that influence treatment outcome, and 4) identify goals for future biofeedback research for pelvic floor dyssynergia. METHODS: A comprehensive review of both the pediatric and adult research from 1970 to 2002 on "biofeedback for constipation" was conducted using a Medline search in all languages. Only prospective studies including five or more subjects that described the treatment protocol were included. In addition, a meta-analysis of these studies was performed to compare the outcome of different biofeedback protocols for treating constipation. RESULTS: Thirty-eight studies were reviewed, and sample size, treatment protocol, outcome rates, number of sessions, and etiology are shown in a table. Ten studies using a parallel treatment design were reviewed in detail, including seven that randomized subjects to treatment groups. A meta-analysis (weighted by subjects) was performed to compare the results of two treatment protocols prevalent in the literature. The mean success rate of studies using pressure biofeedback (78 percent) was superior (P = 0.018) to the mean success rate for studies using electromyography biofeedback (70 percent). However, the mean success rates comparing studies using intra-anal electromyography sensors to studies using perianal electromyography sensors were 69 and 72 percent, respectively, indicating no advantages for one type of electromyography protocol over the other (P = 0.428). In addition to the varied protocols and instrumentation used, there also are inconsistencies in the literature regarding the severity and etiology of symptoms, patient selection criteria, and the definition of a successful outcome. Finally, no anatomic, physiologic, or demographic variables were identified that would assist in predicting successful outcome. Having significant psychological symptoms was identified as a factor that may influence treatment outcome, but this requires further study. CONCLUSION: Although most studies report positive results using biofeedback to treat constipation, quality research is lacking. Specific recommendations are made for future investigations to 1) improve experimental design, 2) clearly define outcome measures, 3) identify the etiology and severity of symptoms, 4) determine which treatment protocol and which component of treatment is most effective for different types of subjects, 5) systematically explore the role of psychopathology in this population, 6) use an adequate sample size that allows for meaningful analysis, and 7) include long-term follow-up data.
引用
收藏
页码:1208 / 1217
页数:10
相关论文
共 79 条
[51]   Identification of patients likely to benefit from biofeedback for outlet obstruction constipation [J].
McKee, RF ;
McEnroe, L ;
Anderson, JH ;
Finlay, IG .
BRITISH JOURNAL OF SURGERY, 1999, 86 (03) :355-359
[52]   Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice [J].
Nehra, V ;
Bruce, BK ;
Rath-Harvey, DM ;
Pemberton, JH ;
Camilleri, M .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2000, 95 (07) :1755-1758
[53]   Randomised controlled trial of biofeedback training in persistent encopresis with anismus [J].
Nolan, T ;
Catto-Smith, T ;
Coffey, C ;
Wells, J .
ARCHIVES OF DISEASE IN CHILDHOOD, 1998, 79 (02) :131-135
[54]   BIOFEEDBACK - NEW MODALITY IN THE MANAGEMENT OF CHILDREN WITH FECAL SOILING [J].
OLNESS, K ;
MCPARLAND, FA ;
PIPER, J .
JOURNAL OF PEDIATRICS, 1980, 96 (03) :505-509
[55]   EFFECTS OF BIOFEEDBACK ON OBSTRUCTIVE DEFECATION - RECONDITIONING OF THE DEFECATION REFLEX [J].
PAPACHRYSOSTOMOU, M ;
SMITH, AN .
GUT, 1994, 35 (02) :252-256
[56]   Biofeedback in colorectal practice - A multicenter, statewide, three-year experience [J].
Patankar, SK ;
Ferrara, A ;
Levy, JR ;
Larach, SW ;
Williamson, PR ;
Perozo, SE .
DISEASES OF THE COLON & RECTUM, 1997, 40 (07) :827-831
[57]   Colorectal dysfunction and faecal incontinence in children with spina bifida [J].
Ponticelli, A ;
Iacobelli, BD ;
Silveri, M ;
Broggi, G ;
Rivosecchi, M ;
De Gennaro, M .
BRITISH JOURNAL OF UROLOGY, 1998, 81 :117-119
[58]   ANISMUS IN CHRONIC CONSTIPATION [J].
PRESTON, DM ;
LENNARDJONES, JE .
DIGESTIVE DISEASES AND SCIENCES, 1985, 30 (05) :413-418
[59]   SSM/I measured microwave brightness temperature (TB's), anomalies of TB's, and their relationship to typhoon intensification [J].
Rao, GV ;
McCoy, JH .
NATURAL HAZARDS, 1997, 15 (01) :1-19
[60]  
RAO SS, 2000, J CLIN GASTROENTEROL, V6, P96