Biofeedback training in persistent encopresis in children with dyssynergic defecation.

Background: Encopresis with dyssynergic constipation is very common in the pediatric population. Biofeedback therapy could be more effective than laxatives, and it has no known adverse effects. In this study, we aimed to evaluate the role of biofeedback training in persistent encopresis in children with dyssynergia. Methods: A randomized clinical trial was carried out on 38 children with dyssynergic-defecation who visited the GIT motility unit--a multimodal treatment of 6 weeks. Children were randomized into two groups. Each group received dietary, toilet advice, enemas, and oral laxatives. One group also received 6 biofeedback training sessions. Outcome measures were 1-Patient-reported outcome measures (Patient Assessment of Constipation Quality of Life (PAC QOL) score; Wexner/Cleveland Clinic Fecal Incontinence Score (CCFIS) and Bristol stool form score (BSFS) were done baseline and 6 weeks after. 2-Highresolution manometry assessment was done before and 3 months after treatment. Results: Both groups showed improvement in constipation-related symptoms and quality of life during treatment (within the biofeedback group, there was a significant decrease in scores from 85.74 to 0, while within the conventional treatment group, the decrease was from 87.63 to 28), there was a statistically significant decrease in incontinence score among the studied groups; with higher scores reported among conventional treatment patients, both groups differed significantly as regard remission at 6th week and 6th months (p=0.022, 0.012 respectively). Full remission occurred in 42.1% versus 78.9% within the conventional group versus biofeedback groups, respectively, in the 6th week. In the 6th month, full remission occurred in 52.63% versus 89.47% within the conventional group versus biofeedback groups, respectively, at the 6th week. Conclusions: Biofeedback combined with conventional treatment could be superior to the conventional treatment alone in managing encopretic patients with dyssynergic defecation; it improved the quality of life, maintaining the continence response and correcting the physiological manometric parameters. [ABSTRACT FROM AUTHOR]