Anorectal Dyssenegira

Biofeedback therapy has been found extremely useful, especially in patients with constipation who have anorectal dyssynergia

The therapy is a technique of stool evacuation by balloon expulsion test with the help of computer-assisted software in real-time.

Most patients were on two or more laxatives and symptomatic for a median of three years (range 1-20 years). A success rate of 70% was seen with biofeedback therapy, with most patients doing well even after discontinuation of laxatives. Younger patients showed a much better response, with success rates of up to 82%.

Interestingly, 88% of the patients had undergone prior colonoscopy for evaluation of the reason for constipation and more than 90% had normal findings on visual inspection of colon alone

After evaluating the cause of constipation, it was seen that incoordination of anorectal function called dyssynergia was present in 56% of patients and slow transit constipation was present in 15% of patients. The rest had either normal transit or IBS type of constipation.

Using advanced tests like anorectal manometry, colonic transit studies and MR defecography, four types of constipation can be diagnosed, and anorectal dyssynergia and irritable bowel syndrome related constipation managed. Patients with constipation are offered personalised and directed treatment, which vastly improves outcomes and greatly enhances satisfaction.