Biofeedback retraining in patients with functional constipation and paradoxical puborectalis contraction

PURPOSE: This study was undertaken to assess the effect of biofeedback therapy in patients with constipation and paradoxical puborectalis contraction and to compare two different feedback modes. METHODS: Twenty-six patients were randomly allocated to either of two feedback modes: anal pressure using a manometry probe or anal sphincter electromyography (EMG) using surface electrodes. RESULTS: Six patients were unable to complete their training; ten patients were retrained using anal manometry and ten patients using EMG. The paradoxical puborectalis contraction disappeared after retraining with manometry feedback in eight of ten patients and with EMG feedback in ten of ten patients. A significant improvement in both bowel function and abdominal symptoms was found after training and a continued improvement at follow-up six months later. Six patients in the manometry group and nine in the EMG group experienced an overall improvement in symptoms. The two feedback methods did not differ in terms of efficacy. CONCLUSIONS: Our results suggest that biofeedback, using either manometry or EMG, is effective in improving symptoms and anorectal function caused by paradoxical puborectalis contraction.