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KMID : 1812020130190040532
Journal of Neurogastroenterology and Motility
2013 Volume.19 No. 4 p.532 ~ p.537
Technique of Functional and Motility Test: How to Perform Biofeedback for Constipation and Fecal Incontinence

Abstract
Biofeedback therapy is an instrument-based learning process centered on operant conditioning. The goal of biofeedback thera-py in defecatory disorders is to strengthen the pelvic floor muscles, retrain rectal sensation and coordinate pelvic floor muscles during evacuation. Biofeedback therapy, in a broader sense, includes education, counseling, and diaphragmatic muscle training as well as exercise, sensory, and coordination training. For dyssynergic defecation, biofeedback therapy is a well-known and useful treatment option that had response rates of approximately 70-80% in randomized controlled trials. Biofeedback therapy for dyssynergic defecation consists of improving the abdominal push effort together with biofeedback technique-guided pelvic floor relaxation followed by simulated defecation and/or sensory training. For fecal incontinence, the results of a randomized controlled trial, which had a response rate of 76%, indicated that biofeedback therapy is useful in selected patients who fail to respond to conservative treatment and that training to enhance rectal discrimination of sensation may be helpful in re-ducing fecal incontinence. The focus of biofeedback therapy for fecal incontinence is on exercising external sphincter con-tractions under instant feedback, either alone or synchronously with rectal distension and/or sensory training. Biofeedback ther-apy is a safe treatment that may produce durable improvement beyond the active treatment period; however, a well-designed study to establish a standard protocol for biofeedback therapy is needed. This review discusses the technique of biofeedback therapy to achieve the goal and clinical outcomes for constipation and fecal incontinence.
KEYWORD
Biofeedback, Constipation, Dyssynergic defecation, Fecal incontinence, Treatment outcome
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