Biofeedback therapy ( BFT ) is an instrument-based learning process; it uses equipment to record or amplify a patient's anorectal activity and then provides feedback to the patient and therapist. The goal of anorectal BFT is to strengthen the pelvic floor muscles, retrain rectal sensation, and coordinate the activity of abdominal, pelvic floor and sphincter muscles during evacuation.
Pelvic floor dyssynergia affects almost 40% patients of chronic constipation. It is an acquired ( i.e. one isn't born with it ) behavioural problem wherein the coordination between the abdominal and pelvic floor muscles to evacuate stools is disturbed. The anal and rectal area contains specialized muscles that are helpful to regulate proper passage of stools during bowel movements. Normally, when stool enters the rectum, the anal sphincter muscle tightens to prevent passage of stool at an inconvenient time. When a person pushes or bears down to have a bowel movement, the anal sphincter muscles relax. This will cause the pressures to decrease allowing evacuation of stool.
However, if the sphincter muscles tighten when pushing, this could contribute to constipation. Thus, in patients with constipation caused due to muscle dyssnergia the anal sphincter muscles do not relax appropriately when bearing down to have a bowel movement creating a functional type of obstruction. These muscles that do not relax with bearing down can be retrained with biofeedback.
As mentioned above, when stools enter the rectum, the anal sphincter muscles tighten to prevent untimely passage of stools, However, if this muscle is weak or does not contract in a timely way, incontinence ( leakage of stool ) may occur. Biofeedback techniques using anal manometry and pelvic floor physiotherapy can strengthen the sphincter muscles and improve rectal sensation. This can help treat faecal incontinence.
At Healing Hands Clinic, manometry is used to gauge pressure changes in the anorectum. The balloon and manometry probe located in the rectum and anal canal record the pressure changes during different manoeuvres. These changes are visible on the monitor for the patient and therapist to see. The therapist explains the results and guides the patient towards changes that are needed in abdominal push effort and recto-anal coordination. The purpose of training in patients with dyssynergic constipation is to create an adequate abdominal push effort that synchronizes with relaxation of the anal sphincters. In faecal incontinence, the purpose is to increase the strength of contraction of the anal sphincter.
BFT is the most effective treatment for chronic constipation due to pelvic floor dyssnergia. After completing the initial training program, periodic reinforcement sessions at 3 months, 6 months and 1 year gives a much better outcome in the long run.
