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  • Review Article
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The role of biofeedback in the treatment of gastrointestinal disorders

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 371–382 (2008)Cite this article

Abstract

Biofeedback is a form of treatment that has no adverse effects and can be provided by physician extenders. The therapy relies on patients' ability to learn how to influence their bodily functions through dedicated machinery and teaching. This Review provides a comprehensive overview of all potential therapeutic applications of biofeedback for functional constipation, fecal incontinence, functional anorectal pain, IBS, functional dyspepsia, and aerophagia. Practical clinical applications of biofeedback therapy supported by randomized, controlled trials (RCTs) are limited to fecal incontinence and dyssynergic defecation. For fecal incontinence, RCTs suggest that biofeedback combining strength training and sensory discrimination training is effective in approximately 75% of patients and is more effective than placebo. However, verbal feedback provided by a therapist during extended digital examination may be equally effective, and children whose fecal incontinence is associated with constipation plus fecal impaction do no better with biofeedback than medical management. For dyssynergic defecation, RCTs show that biofeedback combining pelvic floor muscle relaxation training, practice in defecating a water-filled balloon, and instruction in effective straining is effective in approximately 70% of patients who have failed to respond to laxative treatment. For both incontinence and dyssynergic defecation, the benefits of biofeedback last at least 12 months.

Key Points

  • Biofeedback is considered appropriate when specific pathophysiological mechanisms underlying a disordered function are known and the voluntary control of responses can be learned with the aid of systematic information about functions not usually perceived at a conscious level

  • Biofeedback involves motor skills learning, in which patients are provided with augmented feedback on a physiological response to learn to modify it, discrimination training, in which patients are exposed to graded physiological sensations and taught through feedback on accuracy to perceive weaker sensations, or a combination of the two

  • Among patients with functional gastrointestinal disorders, those with functional anorectal disorders have benefited most from biofeedback training; however, practical clinical applications of biofeedback therapy supported by randomized, controlled trials are limited to fecal incontinence and dyssynergic defecation, for which the benefits of biofeedback last at least 12 months

  • Randomized, controlled trials on dyssynergic defecation and fecal incontinence have shown that studies with adequate study samples, standardized treatment protocols and outcomes, and adequate length of follow-up are possible and that they yield more consistent results

  • The future of biofeedback therapy depends on improving research methodology

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Author information

Authors and Affiliations

  1. G Chiarioni is Deputy Chief of the Division of Gastrointestinal Rehabilitation of the University of Verona, Valeggio sul Mincio, Italy.,

    Giuseppe Chiarioni

  2. WE Whitehead is Professor of Medicine and Adjunct Professor of Obstetrics and Gynecology at the University of North Carolina and Co-Director of the Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,

    William E Whitehead

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  1. Giuseppe Chiarioni
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Correspondence to William E Whitehead.

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Chiarioni, G., Whitehead, W. The role of biofeedback in the treatment of gastrointestinal disorders. Nat Rev Gastroenterol Hepatol 5, 371–382 (2008). https://doi.org/10.1038/ncpgasthep1150

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