About 15% of the population in rich countries suffer from chronic constipation and about a third of these people have dyssynergic defecation. Home biofeedback treatment is an effective option for constipation that is difficult to treat and refractory to usual treatments (nutrition and lifestyle, or drug treatments), conclude these neurogastroenterologists, from Augusta University, experts in motility in digestive health. Biofeedback treatment performed at home actually helps about 70% of patients learn to coordinate and relax the muscles of the bowel and relieve one of the most difficult types of constipation to treat.
Standard treatments such as diet, stool softening, or laxatives may be ineffective in patients with dyssynergic defecation, a form of abdominal and rectal muscle failure. The usual remedies do not address the underlying cause or the lack of coordination between contraction and muscles above the rectum that normally allow movement or motility of stool and relaxation of muscles at the anal opening to allow them to be expelled. Dysynergic defecation can also affect patients who have had problems since childhood or others in adulthood due to different factors such as back surgery or hemorrhoids, or even pregnancy or hysterectomy.
Researchers have developed a biofeedback therapy that allows these patients to better recognize this lack of coordination of muscle movement and improve it. This therapy has been approved by 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 have to travel long distances to practice this biofeedback has raised the question of home treatment. A home biofeedback device has therefore been developed and this trial suggests that it is just as effective, safe and less expensive.
Find a natural and effective muscle pattern: patients with chronic constipation or dyssynergic defecation are forced to make muscular efforts that gradually change their normal behavior towards abnormal behavior. The goal of biofeedback is to help these patients regain a natural and effective muscle pattern. The study is conducted here on 100 patients, half of whom were treated in hospital or treated at home. Experience shows that:
- correction of the problem is observed in 72% of cases in the home group vs. 80% of patients in the hospital group;
- specifically, a total of 83 patients completed the study, 76% in the home group and 90% in the hospital group;
- among those who completed the study, the at-home success rate was actually higher: 92% vs. 84%, suggesting better compliance with therapy at home—a logical result.
- Participants in the 2 groups report similar improvement rates on key parameters (number of complete and spontaneous bowel movements each week, better bowel control, time of expulsion, etc.).
- Treatment costs, including transport costs, are twice as high for therapy in a hospital or specialized center. The fact that the 2 approaches provide similar results and that home care is less expensive should make it the first choice for patients, conclude the researchers.
Finally, a marketable home biofeedback system that can be widely distributed remains to be developed, as the study was conducted using prototypes.