Biofeedback therapy used at home is about 70 percent effective at helping patients learn how to coordinate and relax bowel muscles and relief one of the most difficult-to-treat types of constipation, investigators report.

Standard treatments like more fiber in the diet, stool softeners, even laxatives, tend to be ineffective in patients with this type of constipation called dyssynergic defecation, says Dr. Satish SC Rao, director of neurogastroenterology / motility and the Digestive Health Clinical Research Center at The Medical College of Georgia at Augusta University. About 15 percent of the United States population have chronic constipation, and about one-third of those individuals have dyssynergic defecation.

Rao led development of an office-based biofeedback therapy proven to help these patients better recognize the uncoordinated muscle movement and improve it. The American Gastroenterology Association, the American Neurogastroenterology and Motility Society and the European Society of Neurogastroenterology and Motility have all given the treatment a thumbs up.

However, limited training sites and the fact that many patients must travel long distances multiple times to get to those sites, had Rao and his team also wanting to make the effective approach more widely available and hopefully more cost-effective.sites, had Rao and his team also wanting to make the effective approach more widely available and hopefully more cost-effective. The Lancet . The at-home system they developed appears to be effective, safe and less expensive, they report in the journal  The Lancet .

The National Institutes of Health-funded study looked at a total of 100 patients, half randomly assigned to each group, from January 2005 to January 2010. Looking at all 50 patients who started in each arm, correction of the problem was seen in 72 percent of the home-based therapy group and 80 percent of the office-based group.

Health-funded study

Health-funded study looked at a total of 100 patients, half randomly assigned to each group, from January 2005 to January 2010. Looking at all 50 patients who started in each arm, correction of the problem was seen in 72 percent of the home-based therapy group and 80 percent of the office-based group.

A total of 83 patients completed the study, 76 percent in the home-based group and 90 percent in the office-based group. Based on those who completed the study, at-home success rates were actually higher: 92 percent versus 84 percent, respectively.

Participants in both arms reported similar rates of improvement with key parameters like the number of complete, spontaneous bowel movements weekly, the investigators report. All participants also were able to control their bowel movement, with both groups decreasing the time it took to expel a balloon-which gave them a surrogate sensation of pooping-and decreasing the number of times the balloons unexpectedly discharged.

For the office-based therapy, patients had a training session with a nurse specialist followed by up to six, one-hour sessions over three months. A manometer helped determine whether they were contracting at the top of the foot-long rectum and simultaneously relaxing the bottom, or anus. Patients also learned a variety of breathing and other techniques to enable proper coordination. They received visual and verbal commands to improve coordination while seated on the commode.

They were asked to sit on the commode twice daily and attempt 10-15 push maneuvers while looking at the pressure responses. Lights increased when the anus was being properly relaxed and decreased when they did not relax those muscles. A separate panel of lights would similarly respond to reflect the contraction of muscles at the top of the rectum.

Now that they have the information, the researchers need a biotech firm to develop a home biofeedback system that can be widely distributed, Rao says. For the purposes of the study, Rao used a device made by a friend.