Is biofeedback effective in treating constipation caused by pelvic floor dysfunction?

Although biofeedback may be effective in the treatment of constipation due to pelvic floor dysfunction, the quality of the existing research is insufficient to prove it. (LOE = 2a)

Koh CE, Young CJ, Young JM, Solomon MJ. Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. Br J Surg 2008;95(9):1079-1087.  [PMID:18655219]

Systematic review

Self-funded or unfunded

Various (meta-analysis)

Most constipation can be easily managed with simple remedies: increase fiber and fluids, use laxatives, and so forth. However, patients who don't respond to simple measures have a high rate of pelvic floor dysfunction, thought to be an acquired maladaptive behavior that might be amenable to behavioral therapy. These authors searched several databases to find randomized controlled trials of biofeedback in the treatment of adults with constipation due to pelvic floor dysfunction. Two authors independently determined the eligibility of potential studies and then assessed the quality of each study. Disagreements were resolved by a third author. They identified 7 randomized controlled trials with 413 patients. The overall quality of the 7 studies was poor (high drop-out rates, poor description of randomization procedures, no blinding, etc.). Additionally, all the trials' study populations, study protocols, and outcomes assessments were heterogeneous. Three studies compared biofeedback with other treatments and 4 compared different biofeedback modalities. Although biofeedback in these studies was associated with "treatment success," the quality of the studies was poor enough to cast doubt on the results.