Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026
Short and long-term outcomes of anorectal biofeedback therapy in patients with functional defecation disorders: Efficacy and predictors of response.
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Agarwal Ayush, Anil Abhijith K, Bayye Rajkumar, Agarwal Ashish, Chauhan Ashish, Agarwal Samagra, Netam Ritesh, Mahapatra Soumya Jagannath, Kedia Saurabh, Gunjan Deepak, Shalimar, Ahuja Vineet, Garg Pramod Kumar, Jaryal Ashok Kumar, Makharia Govind K
Аннотация
OBJECTIVES: Functional defecation disorders (FDD), a major sub-type of chronic constipation, often exhibit limited response to pharmacotherapy. Anorectal biofeedback therapy (BFT) is the recommended therapy, but there is limited data regarding its long-term effectiveness and predictors of response. We evaluated the short and long-term effectiveness of a six-session anorectal BFT protocol in patients with FDD.
METHODS: In this ambispective cohort study (2018-2024), adult patients diagnosed with FDD by Rome-IV criteria who completed six BFT sessions were included. The primary outcome was at least 30% improvement in the Modified Cleveland Constipation (MCC) score. Secondary outcomes included changes in symptoms on visual analog scale (VAS), individual symptoms, anorectal manometry parameters and predictors of response to BFT. The patients who had completed at least one-year follow-up were contacted to assess long-term response.
RESULTS: One hundred sixty-six patients were included (median age = 40 years [IQR = 27-52]; 69.3% male). After BFT, 61.4% achieved improvement in MCC score by > 30%, with significant improvement in VAS score and individual symptoms such as incomplete evacuation, straining and manual evacuation (p < 0.001). Post biofeedback, there was significant increase in defecation index and anal relaxation (p < 0.001). Younger age was predictive of short-term response to BFT regardless of different sub-types of FDD. At long-term follow-up of 110 patients (median = 22 months, IQR = 12-28 months), 56.4% reported sustained improvement in MCC score by > 30%, with initial response to BFT being significant predictor of long-term response.
CONCLUSIONS: Anorectal BFT is an effective treatment for FDD with sustained benefit over long term.
METHODS: In this ambispective cohort study (2018-2024), adult patients diagnosed with FDD by Rome-IV criteria who completed six BFT sessions were included. The primary outcome was at least 30% improvement in the Modified Cleveland Constipation (MCC) score. Secondary outcomes included changes in symptoms on visual analog scale (VAS), individual symptoms, anorectal manometry parameters and predictors of response to BFT. The patients who had completed at least one-year follow-up were contacted to assess long-term response.
RESULTS: One hundred sixty-six patients were included (median age = 40 years [IQR = 27-52]; 69.3% male). After BFT, 61.4% achieved improvement in MCC score by > 30%, with significant improvement in VAS score and individual symptoms such as incomplete evacuation, straining and manual evacuation (p < 0.001). Post biofeedback, there was significant increase in defecation index and anal relaxation (p < 0.001). Younger age was predictive of short-term response to BFT regardless of different sub-types of FDD. At long-term follow-up of 110 patients (median = 22 months, IQR = 12-28 months), 56.4% reported sustained improvement in MCC score by > 30%, with initial response to BFT being significant predictor of long-term response.
CONCLUSIONS: Anorectal BFT is an effective treatment for FDD with sustained benefit over long term.