Biofeedback in disordered defecation (fecal incontinence/obstipation)

In gastroenterology, biofeedback training has been shown to be the treatment of choice for 2 groups of patients with disordered defecation: those suffering from fecal incontinence or spastic pelvic floor syndrome; Biofeedback is based on the fact that electrical impulses, generated by an active muscle, can be fed back in the form of audible and visible signals, so that the patients can be taught to recognize and consciously influence normally unconscious body functions such as anal sphincter contraction, rectal sensation or pelvic floor muscle function. In fecal incontinence as well as in spastic pelvic floor syndrome controlled studies have shown biofeedback training to be superior compared to conventional treatment modalities with success rates ranging between 50 and 80%, depending of the efficacy criteria applied. In both cases, a diagnostic strategy to select patients who would profit from this therapy is most important. An analysis of the published biofeedback studies for anorectal dysfunction shows that, although biofeedback is a useful tool in the treatment of these dysfunction, the mechanisms involved in its efficacy are unclear and standardization criteria are still to be found for diagnostic evaluation of patients as well as for outcome evaluation. This article describes the historical development of biofeedback training, the clinical protocols for treating patients with fecal incontinence or spastic pelvic floor syndrome, and gives a short summary of the published studies.