Biofeedback pelvic floor exercise therapy for pelvic floor dyssynergia: an observational study


  • Ashwin Porwal Department of Colorectal Surgery, Healing Hands Clinic, Pune, Maharashtra, India
  • Paresh Gandhi Department of Surgery, Healing Hands Clinic, Pune, Maharashtra, India
  • Deepak Kulkarni Department of Proctology and Enterology, Healing Hands Clinic, Pune, Maharashtra, India



Anal manomentry, Behavioural therapy, Constipation, PFD, Quality of life, Resting pressure


Background: Pelvic floor dyssynergia (PFD) is one of the commonest subtypes of constipation and treated conservatively but is often unsatisfactory. Biofeedback Pelvic Floor Exercise Therapy (BFT) has been introduced as an alternative treatment.

Method: A prospective study was conducted at Healing Hands Clinic, Pune. Total 35 patients diagnosed as having pelvic floor dyssynergia confirmed by MR defecography (MRD) enrolled in to the study. All patients trained for pelvic floor muscle exercise. Patient performed exercise 20 minutes per day for 12 weeks. Data have been collected using a standardized questionnaire (Longo's obstructed defecation syndrome (ODS) score, Patient Assessment of Constipation Quality of Life (PAC-QOL) and Bristol stool score and performed anal manomentry test (3-D HDAM) at every 4 weeks.

Result: Study result demonstrated a statistically significant improvement in the mean resting pressure, maximum squeezing pressure and average of 10 seconds hold (from 69.83±6.40 to 39.87±5.51, 98.67±17.23 to 128.67±26.92, 78.70±15.41 to 109.00±22.23, P = 0.005 at week 12). The mean total ODS decreased significantly (p<0.0005) from baseline to 22.92±4.03 to 11.46±6.76 at week 12. Also, individuals ODS score items were significantly improved at week 8 and week 12. Bristol stool score significantly improved from 2.12±1.14 to 4.04±0.96 at 12 weeks (p<0.0005). Significant improvements were recorded in all four individual score domains (physical discomfort, psychosocial discomfort, worries and concerns, satisfaction) and total score of PAC-QOL at week 12.

Conclusion: Biofeedback therapy provides improvement in bowel symptoms, anorectal function and reduces use of aperients in constipated subjects with pelvic floor dyssynergia


Wen NR, Hu YL, Zhao L, Tuxun T, Husaiyin A, Sailai Y, et al. Biofeedback guided pelvic floor exercise therapy for obstructive defecation: An effective alternative. World J Gastroenterol. 2014;20(27):9162-9.

The grim reality of constipation prevalence in India; 2015. Available at: access on 7 Dec 2015.

Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol. 1992;136:165-77.

Levitt MA, Peña A. Surgery and constipation: when, how, yes, or no?. J Pediatr Gastroenterol Nutr. 2005;41(1):S58-60.

Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SSC. Functional disorders of the anus and rectum. In: Drossman DA,Corazziari E, Talley NJ, Thompson WG, Whitehead WE, eds. Rome II: the functional gastrointestinal disorders. McLean, VA: Degnon Associates; 2000:483-529.

Wainstein C, Carrillo K, Zarate AJ, Fuentes B, Venegas M, Quera R, et al. Results of pelvic rehabilitation in patients with pelvic floor dyssynergy. Cir Esp. 2014;92:95-9.

Leung L, Riutta T, Kotecha J, Rosser W. Chronic constipation: an evidence-based review. J Am Board Family Med. 2011;24(4):436-51.

Bleijenberg G, Kuijpers HC. Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum. 1987;30:108-11.

Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterol. 2006;130:657-64.

Rao SS. Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastrointest Endosc Clin N Am. 2009;19: 17-39.

Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial. Am J Gastroenterol. 2010;105:890-6.

Simon MA, Bueno AM. Behavioural treatment of the dyssynergic defecation in chronically constipated elderly patients: a randomized controlled trial. Appl Psychophysiol Biofeedback 2009;34:273-7.

Whitehead WE, Heymen S, Schuster MM. Motility as a therapeutic modality: biofeedback treatment of gastrointestinal disorders. In: Schuster MM, Crowell MD, Koch KL, eds. Schuster atlas of gastrointestinal motility. 2nd ed. Hamilton, Ontario: BC Decker; 2002:381-97.

Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum. 2007;50(4):428-41.

Şahin M, Doğan İ, Cengiz M, Ünal S. The impact of anorectal biofeedback therapy on the quality of life of patients with dyssynergic defecation. Turk J Gastroenterol. 2015;26(2):140-4.






Original Research Articles