Biofeedback therapy
I. The concept of biofeedback therapy
Every movement of human body is a complex physiological process completed by the coordination and cooperation of various systems, but this physiological process is not perceived by people. For example, the daily defecation activity requires fecal filling of the rectum, causing rectal defecation sensation, which is regulated by the nervous system of the brain, causing the puborectal muscle to relax, the internal and external anal sphincter to open, the abdominal pressure to increase, and the feces to be expelled. If there is a problem with one of these components, it is difficult to pass stool.
Patients also find it difficult to understand: how can they have such an embarrassing situation when they are struggling to pass stool?
With the development of science and technology, this question has become easier, and this is the question that biofeedback technology can answer. Biofeedback technology is a visual and auditory technology that transforms physiological information that the human body cannot detect into signals that can be understood through instruments and fed back to people. With the help of this instrument, the physiological disorder is regulated and corrected to restore it to normal, which is biofeedback therapy.
In the field of constipation, this therapy is mainly used for functional outlet obstruction type of constipation. It solves the spasm of the anal sphincter, corrects the abnormalities of the synergistic movements of defecation and establishes a normal defecation pattern. Foreign biofeedback therapy as the first choice of treatment for constipation due to abnormal defecation reflex, and patients who are not treated with biofeedback therapy are not easily included in the list of surgical procedures.
Second, the biofeedback treatment of constipation equipment
It is a device that combines electromyography and biofeedback therapy host, including a 12 mm diameter, 45 mm long columnar internal myoelectric receptor of the anal canal, three body electrodes of the anterior oblique abdominal muscle, and a biofeedback therapy host and computer connected to it, the computer screen can display and measure the electrical activity of the puborectalis muscle and external anal sphincter, and use it as an objective indicator to record the patient’s reflection.
Third, the principle of biofeedback therapy
1.The principle of diagnostic effect
Using three longitudinal strips of electrodes of EMG biofeedback instrument, firstly, let the patient relax the anus and observe the baseline of resting state, then let the patient contract the anus and see the intensity of contraction of anal sphincter, and finally let the patient do defecation, if the signal is at the normal baseline level, the defecation function is normal; if the signal is similar to that of contraction, it means that the patient has spasm of anal sphincter. It is the abnormal sphincter synergy that causes constipation.
2.Therapeutic effect
Using EMG biofeedback instrument to teach patients to do defecation training, first focus on training to relax the anus, after the patient mastered the basic movements, further training alternate relaxation, contraction, defecation and other movements. After the patient has mastered the basic movements, further training of alternate relaxation, contraction and defecation can be achieved. After the biofeedback training treatment, patients can learn to relax the anal sphincter and exert the septum and abdominal muscles during the defecation action, thus eliminating constipation and restoring a healthy and relaxed life.
Fourth, the selection method of indications
1.Defecation kinetic examination
(1) Absence or incomplete inhibition reflex, with or without increased ISAP.
(2) Increased ISAP accompanied by normal ISA inhibition reflex.
(3) EAS shows reverse contraction or poor relaxation during defecation.
(4) Organic constipation such as defecation ganglion cell deficiency.
2.Pelvic floor EMG examination
Increased EMG activity in the pelvic floor during defecation.
3.Clinical symptoms
Meet the criteria set by our “Constipation Diagnosis and Treatment Workshop” (1990).
(1) Low stool volume, hard texture and difficulty in defecation.
(2) Difficulty in defecation combined with some specific symptoms, such as prolonged straining to defecate, rectal distension and incomplete defecation.
(3) The number of bowel movements is less than 2-3 times in 7 days, and it is often necessary to squeeze the area around the anus with fingers to assist in defecation.
(4) Excluding organic anorectal lesions. If necessary, lower gastrointestinal tract imaging and colonoscopy should be performed.
Fecal imaging can determine the location and nature of outlet obstruction; colonic transmission test can exclude colonic constipation.
V. Steps of biofeedback therapy
1, the number of treatment: 3 this training to the clinic every week, 45-60 minutes each time.
2, the first training.
(1) Interview: including explaining to the patient the problems and etiology in the above examination index; explaining the treatment plan and the mechanism of biofeedback; explaining the corresponding anatomical knowledge; expending the treatment effect and the course of treatment, etc.
(2) Training.
(i) Adopt a sitting position, insert the intra-anal sensor and affix the abdominal electrode.
(②Let the patient learn to observe the changes of EMG activity curve displayed on the screen and understand the feedback relationship between the curve and their own muscle movements.
③ Instruct the patient to make training treatment according to the training course requirements.
3.Follow-up training.
(1) Interview: including daily defecation; home training; diet adjustment and medication use.
(2) Training.
①Return to read the last training waveform.
② Focusing on how to work with Valsalva movements to loosen the pelvic floor muscles.
(3) Adjustment of the wrong muscle groups used.
4. Sensitivity training.
Insert a catheter with a balloon into the rectum, usually 6-10 cm; slowly inject air into the balloon, and the patient should pay attention to the “initial sensation” and “full sensation” of rectal filling. Gradually reduce the amount of balloon injection, the patient knows the amount of inflatable premise to find the feeling of rectal filling, repeated training.
5. Home training.
More than ten people equipped with home trainers, trained twice a day, 10 minutes each time.
6.Defecation records.
This includes recording the patient’s regular defecation records; complete diet records; general training records; and medication-assisted defecation records. This record is generally adhered to for six months.
7.Course of treatment: 4-12 weeks.
VI. Follow-up and efficacy assessment
Review after six months and retrieve the defecation record.
Efficacy assessment: can be divided into two categories: subjective examination and objective examination.
1.Subjective sensory assessment: The defecation record includes the number of spontaneous defecation per week, the number of drug-assisted defecation and the number of enema defecation, and also the patient’s satisfaction level can be used as a subjective assessment method.
2.Objective examination assessment: commonly used are anorectal manometry, electromyography, defecation fractionography, and colonic transmission test.
The clinically reported assessment indicators are as follows.
(1) Clinical symptoms.
Effective: those who can stop all laxatives and have basically normal bowel movements after 10 times or less of biofeedback treatment.
Effective: those who have been treated 15-20 times, basically stop using laxatives, and can have basically normal bowel movements
Ineffective: those who cannot get rid of laxatives and have no improvement in constipation after more than 15-20 times of treatment.
Reported 45 cases of constipation patients, 38 cases of significant effect, 2 cases of effective, invalid 0, there are 5 cases are busy with work, after 5 times of treatment, automatically stop treatment, the total effective rate of 88.8%, close to the efficiency reported abroad.
(2) EMG assessment.
Effective: after biofeedback treatment, EMG indicated that the paradoxical movement of pelvic floor muscles and anterior abdominal muscles disappeared and the amplitude of movement increased.
Ineffective: no improvement in the paradoxical motion amplitude.
(3) Anal pressure detection.
Among 45 patients, 24 cases had lower perception threshold before biofeedback therapy, and 12 patients had higher maximum volume tolerance. After biofeedback therapy improved the symptoms, most patients’ perception test returned to normal.
Seven, the advantages of biofeedback therapy
1.Avoiding surgery, non-invasive treatment.
2.No pain, no adverse drug reactions.
3, safe and reliable, will not cause complications and sequelae.
4, high success rate and low recurrence rate, better long-term results.
5.Clean, clean and hygienic.
6.Simple operation.