Abstract
Aim: Recently we reported reasonable effectiveness of biofeedback with balloon expulsion training alone for the treatment of functional defecation disorder due to pelvic floor inco-ordination. Since then, we added anal electromyography for the relaxation training of pelvic floor muscles. In this study, the "authentic" biofeedback with anal electromyography and balloon expulsion training was evaluated for the treatment of this disorder. Methods: Between August 2010 and May 2011, 19 patients with defecation disorder due to pelvic floor incoordination were treated with biofeedback using anal electromyography and balloon expulsion training, and formed the subjects of this study. The constipation symptom severity and the constipation-specific quality of life were evaluated with modified Constipation Scoring System (mCSS, no constipation:0 - worst:26) and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL, best:1.0 - worst:5.0), respectively. The anal electromyographic activity on straining was compared between at the first and at the last session of biofeedback. Results: The median age was 73 years old (range:62 - 85) and 13 were male. The median mCSS improved significantly (P=0.0005) from 12 (6 - 18) at the first visit to 10 (4 - 14) before biofeedback, and further improved significantly (P=0.004) to 5 (3 - 12) after biofeedback. The median PAC-QOL also improved significantly (P=0.009) from 3.3 (1.7 - 4.6) at the first visit to 2.7 (1.7 - 3.8) before biofeedback, and further improved significantly (P<0.0001) to 1.5 (1.0 - 2.7) after biofeedback. The anal electromyographic activity on straining significantly decreased from a median of 9μV at the first session to 4μV at the last session of biofeedback. Conclusions: By adding anal electromyography to balloon expulsion training for the treatment of patients with defecation disorder due to pelvic floor inco-ordination, the effectiveness of biofeedback was further reinforced with both of constipation symptom and constipation specific quality of life having significantly improved.
