I have constipation. Is biofeedback a good option?

Question

Hello, doctor,

I am 34 and have had severe constipation for over a year. I go only twice a week and always strain. My recent colonoscopy was normal, but anorectal manometry showed reduced rectal sensation and incomplete relaxation. My GI doctor mentioned pelvic floor dysfunction and referred me for biofeedback therapy.

I am currently taking Polyethylene glycol daily, but it does not help much. I want to know the following:

Is this a lifelong condition, or can therapy cure it?
What is the success rate of biofeedback for this kind of constipation?
Additionally, are there dietary changes that can make a significant difference in conjunction with therapy?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

What you are describing is dyssynergic defecation. It is a form of pelvic floor dysfunction that is quite common in people with chronic constipation, especially when there is straining and a feeling of incomplete evacuation. The good news is that it is not necessarily a lifelong condition. Biofeedback therapy has a high success rate, with up to 70 to 80 % of patients improving significantly, especially when it is guided by trained therapists using manometry or EMG (electromyography) feedback.

The goal is to retrain the pelvic muscles to relax appropriately during bowel movements and to enhance rectal sensation, both of which your manometry showed as impaired. Polyethylene glycol (PEG) helps soften stool but will not correct the underlying pelvic muscle dysfunction, so combining it with biofeedback therapy is key.

As for diet, increasing fiber (especially soluble fiber like psyllium) and hydration are essential, but in cases like yours, the effect is limited without addressing the muscle coordination issue. Still, a diet rich in fruits, vegetables, whole grains, and low-FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) foods (if bloating is also an issue) can help. And some people also benefit from scheduled toileting, physical activity, and avoiding excessive straining.

With the right therapy, many patients experience long-term relief without needing daily laxatives. Sticking with the full course of biofeedback and maintaining good bowel habits gives you the best chance of achieving lasting improvement.

I hope this helps you.

Thank you.