Summary

Biofeedback is a complementary and alternative therapy for some digestive system disorders. In this therapy, patients are trained to use their mind tFecal incontinence is the inability to control fecal function and bowel movements.o control body functions that are typically involuntary (e.g., muscle tension, heart rate). Biofeedback is used to help patients regain control of their bowel movements if they have disorders such as fecal incontinence or constipation. It can also be used to help patients learn to control stress that contributes to ulcers or irritable bowel syndrome.

Little is understood about how biofeedback works. Both patients and physicians are often at a loss to explain the mechanics of the therapy. Though biofeedback appears to be an effective treatment for some individuals, other patients are not successful at mastering the techniques involved.

There are several different types of biofeedback, including bowel training, electromyography, neurofeedback, thermal biofeedback, galvanic skin response training and the forced oscillation method. Bowel training is the method most often used to treat digestive disorders. Before beginning biofeedback therapy, patients should check to make sure the therapist is certified by the Biofeedback Certification Institute of America (BCIA).

Biofeedback training can occur in a variety of facilities (e.g., physical therapy clinics, medical centers, hospitals) and typically lasts for 30 to 60 minutes. Before biofeedback training, sensors are placed on the patient’s body. The patient is given auditory or visual cues to indicate body functions. The patient then learns to associate these functions with symptoms, and to control the functions to ease the symptoms. Patients who are trying to improve control of their bowels through bowel training will have a pressure-sensitive probe inserted into their anus to measure the muscle strength and activity of the anal sphincter. They then will use biofeedback to practice strengthening these muscles. Eventually, the patient learns to control body functions without help from a therapist.

Rectum & Anal Canal
Biofeedback may decrease medical costs by reducing patients’ need for medication. It puts the patients in control of their own treatment. For most patients, biofeedback therapy is very safe. However, because it may interfere with some medications, it is important to discuss biofeedback thoroughly with a physician, particularly if the patient is suffering from certain conditions (e.g., diabetes)

About biofeedback

Biofeedback is a therapy in which the patient learns to gain partial or complete control over various typically involuntary body functions. It belongs to the category of mind-body therapies, which seek to strengthen communication between the mind and body. This therapy is non-pharmacological, meaning that it does not involve the use of medications.

The goal of biofeedback is to use the mind to control the body. Therapists teach patients how to control certain involuntary body responses using feedback from a variety of monitoring procedures and equipment. This equipment usually displays biological data (e.g., heart rate, muscle tension) in a visual or auditory form, which allows a patient to become aware of body processes that are otherwise controlled unconsciously. By slowly learning to control these responses, patients can overcome various mental and physical health issues. Eventually, patients are able to control their body's response without the aid of the visual or audio cues.

Mastering relaxation techniques, whether in a specific body part or in the entire body, is often a large part of biofeedback. Controlling certain body functions, such as heart rate and muscle stress, can often reduce tension and pain.

Patients who participate in biofeedback may learn to control many involuntary body responses, including:

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      Muscle tension
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      Brain wave activity
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      Skin temperature
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      Respiration
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      Heart rate and circulation
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      Blood pressure

Biofeedback’s role in treating digestive system conditions usually involves helping patients to better control their bowel movements. Patients diagnosed with fecal incontinence (an inability to control the bowels) or constipation (e.g., due to a problem with their sphincter or pelvic floor muscles) may use biofeedback to help improve their bowel control. Recent study findings suggest that biofeedback is much more effective than laxatives in treating constipation associated with pelvic floor dyssynergia (inappropriate contraction or inability to relax the muscles of the pelvic floor when deficating). In some cases, biofeedback can be so effective that it actually cures the patient’s digestive condition.

Digestive System

Different methods of biofeedback training are used depending on the condition and goals of the individual patient. Some of these methods include electromyography (EMG), neurofeedback, which employs an electroencephalogram (EEG, a recording of brain activity), and galvanic skin response training, which measures perspiration. Diaries or journals may be useful in determining the effectiveness of an individual patient’s use of biofeedback.

Biofeedback techniques have only been developed within the last half-century and much about them is still not understood. Patients who use biofeedback often cannot explain how they control their body functions to relieve their symptoms. Even physicians do not fully understand how biofeedback works. However, patients who use the therapy often say that they feel more in control and confident about their condition and symptoms. Once the techniques are learned in a clinical setting, the patient may be able to control body functions without the assistance of a therapist.
Biofeedback may be used in conjunction with other treatments or therapies (complimentary therapy) to improve their effectiveness. It may also be used as an independent treatment alternative (alternative therapy), particularly for patients who do not respond to or have adverse effects with traditional therapies. Biofeedback certification is available from the Biofeedback Certification Institute of America (BCIA). Although this certification is voluntary (it is not required), many biofeedback therapists in the United States choose to become certified.

Types and differences of biofeedback

The techniques used to teach biofeedback depend upon the individual patient’s health problems and the goals patients wish to accomplish. Methods and equipment that may be used include:

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      Electromyography (EMG). Sensors (e.g., electrodes) are attached to the skin to measure the electrical activity of the muscles. This activity relates to muscle tension, which can influence or cause pain and stress. The patient learns to recognize tension early and control it right away. This can be used to help treat disorders worsened by stress, such as some types of ulcers and irritable bowel syndrome.

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      Bowel training. A pressure-sensitive probe is inserted into the anus to register the strength and activity of the anal sphincter. This training allows patients to practice sphincter contractions and learn to strengthen the rectal muscles. It can help some patients with fecal incontinence. Biofeedback has recently been shown to be superior to laxatives in certain cases of chronic constipation.  Pelvic floor dyssynergia, a condition known to cause chronic constipation, responds very well to biofeedback.

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      Neurofeedback. An electroencephalogram (EEG, a recording of brain activity) is used to monitor brain wave activity and teach patients to alter it. This activity may be linked to different mental states, such as wakefulness, relaxation, calmness and light or deep sleep.

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      Thermal biofeedback. Sensors are attached to the patient’s fingers and feet to measure skin temperatures. These temperatures often drop when the patient is under stress, so a low reading can prompt the beginning of relaxation techniques.

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      Galvanic skin response training. Sensors measure perspiration and sweat gland activity, which may be linked to stress.

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      Forced oscillation method. The patient breathes through a tube and pressure and flow of the breath are assessed using a device called a pneumotachometer. This method teaches control of respiration.

Before, during and after biofeedback

Many physicians encourage patients to find the right therapist for biofeedback. The Biofeedback Certification Institute of America (BCIA) certifies therapists throughout the United States. To receive certification, the therapist must be a licensed healthcare professional or work under the guidance of such a professional. These therapists are accustomed to dealing with patients and typically have a good bedside manner. If a BCIA–certified therapist is not available, a medical expert may be able to recommend a non-certified therapist.

Patients should follow any preparatory recommendations made by their physician or therapist prior to a biofeedback session. Biofeedback training can occur in a variety of facilities (e.g., physical therapy clinics, medical centers, hospitals) and a session typically lasts for 30 to 60 minutes. The number of sessions required varies among individuals.

The therapist applies electrical sensors (electrodes) to different parts of the patient’s body. These electrodes are connected to monitors that give feedback in the form of auditory (e.g., beeping, clicking sounds) or visual (e.g., flashing light, changing color) cues. The patient begins to associate the body’s responses (symptoms) with certain physical functions (e.g., tense muscles, elevated heart rate). In this manner, the patient learns how to make positive physical changes (e.g., relax muscles, reduce heart rate) to alleviate the symptoms. Relaxation helps the patient to master this control.

In biofeedback used to teach improved bowel control, a pressure-sensitive probe is inserted into the anus to measure the muscle strength and activity of the anal sphincter. Patients can strengthen their anal muscles by practicing sphincter contractions known as Kegel exercises and watching an electronic readout that displays the strength of their efforts. The exercises help strengthen the muscles of the pelvic floor, including those that help a patient control stool passage from the body.

The eventual goal of biofeedback training is for the patient to exercise this control alone, without the assistance of a therapist or technology.
Many patients find it useful to assess the effectiveness of biofeedback by keeping a daily diary to monitor their use of the treatment. They record how they feel before, during and after the therapy. Therapists often conduct a similar profile of their patients, recording physiological values during the tests and after the tests as well as the extent of the patient’s recovery.

Potential benefits and risks of biofeedback

The results of biofeedback vary by individual. In successful treatments, biofeedback may allow patients to reduce or even eliminate their need for medication. The therapy also has the potential to increase the effectiveness of other treatments or help conditions when the patient fails to respond to other treatments. In some instances, it may decrease medical expenses by removing the cost of other pain medications or therapies.

Biofeedback can also have psychological benefits. It may give patients control of their own healing and allow them to better monitor their own progress.
Biofeedback is considered very safe. However, it is wise for patients to be cautious and discuss the therapy with their physician thoroughly if they are suffering from depression, severe psychosis, diabetes or other endocrine disorders. This is because biofeedback may interfere with some medications for these conditions.

Questions for your doctor about biofeedback

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to biofeedback:

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      Am I a good candidate for biofeedback?

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      How can biofeedback help me to control my bowel movements?

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      Can you recommend a certified biofeedback therapist for me?

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      How many times will I have to attend biofeedback training before I’ll be able to practice it on my own?

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      How often should I practice biofeedback?

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      Will this form of biofeedback cause me any pain or discomfort?

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      Should I use a journal to record my experiences with biofeedback?

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      Will biofeedback improve the effectiveness of any of the treatments I am currently undergoing?

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      Will biofeedback interfere with any of the medications I am currently taking?

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      Should I restrict my use of biofeedback in any way because of my condition?