Non-pharmacological therapy: biofeedback and more

The diagnostic and therapeutic approach of chronic constipation (CC) is based on a clinical algorithm that, in the absence of alarm signs, does not initially require complementary diagnostic tests. In these cases, management relies on non-pharmacological measures, such as lifestyle and bowel habit modifications, and on pharmacological treatment with fiber, osmotic and stimulant laxatives, and to a lesser extent prokinetics. However, in refractory CC, patients should undergo evaluation with pelvic floor physiology tests, such as anorectal manometry, defecography, and electromyography. This assessment allows the diagnostic spectrum to be expanded toward defecation disorders, rectal sensitivity disorders, and structural pelvic floor pathology, entities in which pharmacological measures are insufficient for effective medical management. Within this group, defecation disorders represent the prototype pathology that benefits most from anorectal biofeedback therapy, with a reported prevalence of up to 40% in patients with EC. Anorectal biofeedback is a therapy based on an instrumental rehabilitation process aimed at training the motor and sensory function of the posterior pelvic floor structures, through techniques instructed and supervised by the operator. Multiple biofeedback modalities exist, but all share the same principle: the integration of visual, auditory, and sensory feedback. The effectiveness of this therapy ranges from 60-80%, and in the case of biofeedback with sensory rehabilitation for rectal hyposensitivity, from 56-81%. The objective of this review is to describe the types, indications, and techniques of anorectal biofeedback, as well as other non-pharmacological therapeutic measures used in the treatment of chronic constipation.