Biofeedback Treatment with Balloon Expulsion Training for Defecation Disorders due to Pelvic Floor Inco-ordination

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  • 骨盤底筋協調運動障害を呈する便排出障害型便秘症に対する直腸バルーン排出訓練によるバイオフィードバック療法の効果に関する検討

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Aim: Biofeedback has been reported to be effective in treating functional defecation disorders due to pelvic floor inco-ordination. In this study, the biofeedback with balloon expulsion training was evaluated for the treatment of these disorders. Methods: Out of 152 patients who visited our institution complaining of constipation between September 2008 and August 2009, 43 demonstrated pelvic floor inco-ordination on defecography. Out of them, 21 were treated with biofeedback using balloon expulsion training and formed the subjects of this study. The constipation symptom severity and the constipation-specific quality of life were evaluated with modified Constipation Scoring System (mCSS, no constipation:0-worst:26) and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL, best:28-worst:140), respectively. The patient satisfaction was assessed by five categories. Results: The median age was 21 years old (range: 62-80) and 17 were male. The median mCSS improved significantly from 12 (6-17) at the first visit to 9 (3-18) before biofeedback (P=0.013). It made a further improvement to 8 (3-17) after biofeedback, but did not reach a statistical significance (P=0.08). The median PAC-QOL tended to improve from 84 (39-131) at the first visit to 66 (41-130) before biofeedback (P=0.053), and further improved significantly to 50.5 (33-123) after biofeedback (P=0.0005). Regarding the patient satisfaction, 7 patients were "extremely satisfied" and 6 were "quite a bit satisfied", resulting in 13 (61%) being satisfied with the treatment. Conclusions: With the biofeedback using balloon expulsion training, the constipation symptom tended to ameliorate and the quality of life significantly improved in patients with defecation disorders due to pelvic floor inco-ordination. In order to improve the success rate by refining our biofeedback method, we will adopt pelvic floor muscle relaxation technique using an anal electromyography and the authentic biofeedback method with some dedicated computerized software.

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