Specific Treatment – When muscles under voluntary control in the pelvic floor fail to relax in the way needed for a normal pattern of defecation, their function is best improved through various learning procedures.
Neuromuscular training using biofeedback techniques has been shown to be beneficial. Symptom improvement has been reported in more than two-thirds of patients.
The goal of neuromuscular training using biofeedback techniques is to restore a normal pattern of defecation. Neuromuscular training or biofeedback therapy is an instrument-based learning process.
In biofeedback, special sensors and a computer are used to painlessly monitor muscle and sensory responses. Bowel training additionally may involve special devices used to practice having a bowel movement. Working with a knowledgeable therapist, the patient learns to change abnormal responses to more normal patterns.
In patients with dyssynergic defecation, there are usually two goals of neuromuscular training:
- To correct the abnormal coordination (dyssynergia) of the abdominal, rectal, and anal sphincter muscles in order to achieve a normal pattern and complete evacuation
- To improve rectal sensory perception if rectal sensation is impaired
The patient will undergo repeated sessions of biofeedback therapy training. During training, the individual will learn several things:
- How the muscles of the pelvic floor work during defecation
- How to use abdominal muscles and diaphragmatic breathing to improve push effort
- How to relax the pelvic floor during a bowel movement
- How to be more aware of the sensation of rectal fullness or desire to defecate
The number and length of neuromuscular training sessions varies depending on individual needs. Typically at our clinic in Augusta, Georgia, each training session takes one hour. On average, 4 to 6 training sessions, performed once every two weeks, are required. After completion of neuromuscular training, we have found that periodic reinforcements at six weeks, three months, six months, and twelve months may provide additional benefit, and also improve the long-term outcome.
There are several means and methods available to perform biofeedback therapy for pelvic floor dyssynergia. Effective therapy requires a specially trained therapist working closely with a willing patient and a multi-disciplinary approach. The therapy has no adverse effects.
However, effective biofeedback therapy to treat dyssynergic defecation is only offered in a few centers. This lack of availability is in part due to lack of insurance payment for this simple, yet effective therapy. Hopefully, through public awareness and education of insurance payors this treatment program can become more widely available.