Annual Scientific Meeting
Introduction: The prevalence of constipation among older adults is estimated to be as high as 40% (Melton et al, 1996). Dyssynergic defecation (DD) is an important cause of constipation for a large proportion of these patients. While biofeedback (BFB) therapy has been shown to be highly effective in correcting DD, it involves operant conditioning which requires learning new techniques and few studies have looked at how older adults respond to BFB.
Methods: This is a retrospective analysis of age 65+ patients enrolled in BFB for DD between 2015 to 2018 at a tertiary referral motility program. For patients that had greater than two sessions, survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each BFB visit. 58 patients met criteria. ARM is utilized with sensors in the rectum and anal canal. Stool retention simulation is performed involving inflation of a rectal balloon during the BFB sessions.
Results: Patients described improvement in several meaningful clinical outcomes. The overall median education level was completed high school and some college. Mean global bowel satisfaction on a scale of 1 (very dissatisfied) to 10 (very satisfied) showed a statistically significant increase, 2.77 to 5.01 with BFB (p=< 0.0001). In addition, the important symptom of a feeling of incomplete evacuation after stooling decreased from 95% down to 24% (p=0.0025). Most significantly, 79% of the age 65+ patients showed resolution of their dysyynergia on HR-ARM at their final session (p=0.0006). The defecation index (DI), intrarectal pressure divided by intra-anal pressure during simulated defecation, also trended towards improvement (0.564 to 0.681, p=0.12). In terms of types of dyssynergia (1 through 4), subjects with defects in both propulsion and paradoxical contraction of sphincter muscles during defecation, i.e. type 2 dyssynergia, showed the most substantial objective gains in defecation index, with an average increase of 0.486, p-value 0.01 (2 vs 1) and 0.02 (2 vs 3).
Discussion: Biofeedback for DD shows meaningful improvement in both patient reported outcomes and objective manometric parameters in older adults. This is an important finding because our data supports the efficacy of BFB among older adults, across all levels of education. Given the profound burden of constipation with DD in older adults, we propose biofeedback therapy continue to be given strong consideration as first line therapy for this population.