How to treat functional constipation with biofeedback

  With the aging of the population, the change of diet structure and the influence of psycho-spiritual and social factors, the prevalence of chronic constipation in China is increasing year by year. There are numerous constipated people, however, only a few patients will choose to go to the hospital, and many constipated people take laxatives on their own, abusing laxatives to cause adverse reactions such as laxative dependence and laxative colonization, and even produce significant anxiety or depression, which decreases the quality of life and increases the difficulty of treatment. During normal defecation, the puborectalis suspensory ligament and external anal sphincter relax, but some patients with chronic constipation cannot contract or relax the puborectalis or external anal sphincter well during forceful defecation, thus making defecation obstructed, which is called pelvic floor muscle synergy disorder or anal spasm. It is now believed that this functional disorder is not due to nerve damage but to maladaptation, and that with training, at least 2/3 of patients can master the relaxation of the external anal sphincter and the puborectalis muscle.  Biofeedback therapy is based on operative conditioned reflexes, and special equipment is used to amplify the information of small physiological activities of the human body and convert it into easily recognizable screen signals. Through doctor’s guidance, patients can complete normal defecation movements according to the changing pattern signals on the screen, learn to coordinate the movements of anal and abdominal muscle groups, correct abnormal myoelectric activities, adjust physiological responses, re-establish correct defecation feedback It also coordinates the relaxation of the puborectalis suspensory ligament and external anal sphincter to achieve the purpose of treating constipation. A number of foreign guidelines for the diagnosis and treatment of functional constipation have recommended this therapy. The Yangzhou guideline of chronic constipation in China in 2007 also recommended biofeedback therapy as a reliable treatment for outlet obstruction constipation. Research data show that the effective rate of this therapy for functional constipation is 73%-76%, and it has better efficacy for all types of constipation, especially for outlet obstruction type constipation.