Biofeedback for Constipation

Introduction

Any disorder or condition that affects the gastrointestinal tract is termed ‘gastrointestinal disorder.’ A group of hollow organs that line up from the mouth to the anus is called the gastrointestinal tract. It constitutes the mouth, esophagus, stomach, small intestine, large intestine, and anus. The gastrointestinal tract, liver, pancreas, and gallbladder form the human digestive system. The nerves and the hormones join hands to regulate the smooth functioning of the digestive system. Bacteria in the gut, called gut bacteria or gut microbiota, are important for proper digestion, immunity, and overall well-being.

What Are Gastrointestinal Disorders?

There are a number of conditions that can affect the gastrointestinal health. This, in turn, can impact the digestive system and overall health. Constipation is one of the most common gastrointestinal disorders seen. This article discusses the use of biofeedback for managing constipation.

What Is Constipation?

A condition where the person faces difficulty in passing stool or has uncomfortable and infrequent bowel movements. A person is generally considered constipated when passing hard and dry stool less than three times a week. However, the frequency of bowel movements can differ from person to person.

What Are the Signs of Constipation?

The main signs of constipation are infrequent bowel movements and the passage of dry and hard stools. The other signs can include:

• Bloating.

• Distended abdomen.

• Pain during bowel movements.

• Development of hemorrhoids (a condition where the veins in the anus and rectum become swollen and often bleed).

• Painful bowel movements.

• Sluggishness.

What Are the Causes of Constipation?

The hard and dry stool is due to the colon absorbing too much water from it. In a normal person, as the food moves through the intestine, the colon absorbs water while the waste is removed. The contractions and relaxations of the muscles cause the stool to reach the rectum. By the time it reaches the rectum, most of the water would have been absorbed by the colon, making the stool in its solid form.

When the contractions of the colon become slow, the movement of the stool through the colon becomes slow. As a result, more water gets absorbed by the colon, making the stool dry and hard. The most common causes of constipation include:

• Medications like antidepressants, iron supplements, or opioids.

• Lack of physical activity.

• Dehydration.

• Lack of fiber in the diet.

• Irritable bowel syndrome.

• Ignoring the urge to defecate.

• Changes in food habits or lifestyle.

• Pregnancy.

• Old age.

• Intestinal disorders.

• Overuse of laxatives or stool softeners.

How Is Constipation Managed?

Changes in diet and lifestyle are the first line in managing constipation. A high-fiber diet and regular exercise can bring about great changes. Food like beans, whole grains, bran cereals, fresh fruits, and vegetables can be added to the diet to increase fiber intake. Increasing the water consumption also serves the purpose. Medications like laxatives help to increase the bulk and make the stool soft. Chronic constipation due to improper functioning of the anal and rectal muscles can be treated by biofeedback therapy.

What Is Biofeedback Therapy in Constipation?

Two small muscles in the opening of the anus, called the internal and external sphincters, control bowel movements. Normally, they are closed to prevent the leakage of stool. When there is an urge to pass stool, these muscles must relax and open at the same time to enable the passage of stool. These muscles function in coordination with the abdominal and pelvic muscles, causing the stool to pass out.

In some people, the body might be confused with these signals, resulting in the muscles not working in coordination. This can cause pain, constipation, or difficulty in passing bowels. Using biofeedback therapy, the anal muscles are trained again to function in coordination with the other muscles. Special exercises are given to the pelvic muscles using visual and sensory prompts.

How Is Biofeedback Therapy Done in Constipation?

It is usually done in a private setting with the help of a trained physical therapist. A physician, nurse, and occupational therapist can be trained for this therapy. A probe is inserted into the anal sphincter. Sticky pads are kept on the abdomen to detect the movement of the anal sphincter and the abdominal muscles as defecation is simulated.

The exact mechanism of biofeedback therapy still remains unclear. Visual or verbal feedback is provided on what is being done using the abdominal wall muscles and anal sphincter during the bowel movement. The patient will learn how to strain correctly, which requires learning time. The session can last 45 to 60 minutes per session, with a gap of not more than one to two weeks. A minimum of two to four such sessions would be necessary to see results. The physical therapist will guide the patient in retaining the coordination of the pelvic floor muscles through breathing exercises, exercises to strengthen the pelvic floor muscles and relaxation techniques.

How Efficient Is Biofeedback Therapy in Constipation?

Clinical trials show an improvement in signs of constipation from 44 percent to 100 percent. The endpoint of the treatment (criteria to measure the success of the treatment) is not properly defined, and hence, measuring the success of the treatment must be done with caution. However, the outcomes of various studies have given results superior to other treatment options like diet and lifestyle modification or the use of medications like laxatives.

Biofeedback therapy is a multi-disciplinary approach that requires the patient to be consistent. A trained therapist is essential to bring about a good result. It is debatable whether the therapy can be successful if the patient does it alone. This is because the patient might not be evaluating the signals accurately to bring about the movements in the muscles.

Conclusion

Constipation is a chronic condition that results in infrequent bowel movements and hard and dry stool passage. It could be due to some medications taken, a low-fiber diet, lack of physical activity, etc. Changes in diet and lifestyle have been shown to be effective in managing constipation. Biofeedback therapy is used to treat chronic constipation that is difficult to manage by these changes. Studies show that biofeedback therapy has shown a superior result when compared to other approaches in managing chronic constipation. The muscles involved are re-trained to contract and relax in coordination in this therapy.