Biofeedback: An Innovative Treatment for Constipation, Free of Risks and Side Effects

People suffering from constipation are usually directed to difficult-to-implement changes in habits or medication that often involve unpleasant side effects. It doesn’t have to be this way - Researcher Noa Guzner and Dr. Lior Zornitzki talk about a promising method that may bring relief in many cases.

Constipation is the most common gastrointestinal complaint, and most of us are likely to know how it feels. Its medical definition is a change in the characteristics of bowel movements, which may include discomfort and reduced frequency of bowel movement, with a smaller amount of stool, or stool that is harder than normal.

Constipation may trouble any person at any stage of their life, but there are some known risk factors such as older age, insufficient physical activity, and an unbalanced diet, and it is more common in women than it is in men. A minority of people may experience chronic constipation, defined as prolonged constipation that appears more than 25% of the time over a period of three months. 

This article will discuss a particular type of constipation known as anismus, which is caused by lack of coordination between the muscles and nerves in the pelvic floor which, among other things, drive the digestive system.  For instance, when the sphincter muscles do not relax properly, it becomes difficult to pass stools (hypertonic pelvic floor). At this stage, the reason for this fault is not fully understood, but there are risk factors for it, such as irritable bowel syndrome, slow colonic transit time, mental disorders, etc. 

There are many treatments for constipation which primarily involve lifestyle changes, such as regular physical activity and maintaining regular times for bowel movements, mostly in the first two hours after waking up and about half an hour after a meal. There is also a variety of medication-based solutions, primarily laxatives, and stool softeners, as well as targeted medication. In particularly extraordinary cases, surgical options exist as well – but none of these options are easy to implement or risk-free. 

In recent years, treatment with biofeedback has been on the upswing for many indications. Among other things, this approach is being studied and implemented as a possible treatment for functional constipation. The method is based on learning, developing awareness of and controlling processes in one’s body based on feedback received from data such as heart rate, breathing, perspiration, contraction of muscles, temperature, and more. During the activity, a patient has pain-free monitoring electrodes attached and data received from various body systems are presented to them on a screen. There are various training methods with diverse results, but as a rule, findings from previous studies indicate an improvement of over 50% in patients suffering from constipation due to dyssynergia.  

A randomized controlled trial (RCT) examined the efficacy of biofeedback compared to sham treatment and compared to the standard-of-care treatment in 77 participants that suffered from constipation due to dyssynergia: 28 participants in the biofeedback group, 25 participants in the sham treatment group, and the rest of the participants were in the standard-of-care treatment group. The participants have suffered from constipation for 17 years on average prior to the trial. The trial results demonstrated a statistically-significant difference in the number of complete spontaneous bowel movement in the biofeedback group compared to the other two groups – that is to say, constipation was reduced significantly. Trial participants in the biofeedback group also expressed a greater deal of satisfaction in comparison to the participants in the other groups.

Another study examined the efficacy of the treatment in the longer term. 13 participants who suffered from constipation due to dyssynergia were treated with biofeedback, and 13 additional participants received the standard-of-care treatment over a period of one year. This study also demonstrated a significant improvement in the number of bowel movements and additional bowel motility measures in the biofeedback group over the year of follow-up.

One of the major advantages of biofeedback is the fact that it is pain-free and is practically free of side effects for the patient – in contrast to many of the existing medications used for treating constipation. The main limitations of the studies that examined the use of biofeedback were the relatively short follow-up time and the fact they were conducted with fairly small groups of patients, therefore, implementing their conclusions on a broader population of patients is still problematic. 

In summary, biofeedback may lead to a significant improvement in the quality of life of many people with constipation. Treatment with biofeedback is effective and does not involve any significant side effects. One should make sure the treatment is performed by qualified and skilled practitioners.