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Biofeedback Treatment for Dyssynergia-Type Constipation

Everyone experiences constipation, sometime! Maybe it was on vacation and you felt bloated and miserable; or when you were busy at work and had to rush to complete a task. In any event, you felt ‘awful’. Maybe you couldn’t zip your favorite jeans due to abdominal bloating, maybe you experienced lower abdominal discomfort or experienced a painful ‘movement’ once you went. There are many people who experience these symptoms and more on a daily basis. When someone finally gets the courage to see a specialist about this problem, they might be diagnosed with ‘pelvic floor dyssynergia’ or ‘muscle incoordination’.

Pelvic muscle dyssysnergia (incoordination) refers to the action that occurs in the pelvic floor musculature at the time of defecation. It can become a withholding pattern and in the case of vacation or a change in your work schedule, it can simply be tensing the muscle to avoid the bowel movement (due to inconvenience) rather than heeding the ‘call’. Over time, if this behavior is repeated, it becomes muscle memory; instead of relaxing the pelvic muscle to defecate, the patient tenses the muscle; thus the term dyssynergia or incoordination. The function of the pelvic floor for bowel function is to provide closure of the anal canal to maintain continence. The muscle should signal the rectum and the colon when to defecate and should provide opening of the anal canal by total relaxation to allow for complete and effortless elimination. A dyssynergic pattern shuts the opening of the canal by tensing the muscle to prevent elimination. Thus an incoordination.

The research by Heymen, Scarlett, Ringman, Drossman et al entitled “Randomized, Controlled Trial Shows Biofeedback to Be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation” supports the value of biofeedback in the treatment of this withholding pattern associated with stool elimination. This study supports the benefit of biofeedback treatments using internal sensors to provide the feedback displayed on a computer screen for visualization. This study goes on to say, “We also have shown that the machines are necessary—instrumented biofeedback is an essential element of successful training; however, there is a shortage of practitioners who are trained to provide this form of biofeedback, and there are few clinics where biofeedback instruments are available and where this form of biofeedback can be obtained”.

Biofeedback provides visual and auditory feedback of muscle tension. It is a non-invasive technique that allows patients to adjust muscle function, strength, and behaviors to improve pelvic floor function. The small electrical signal (EMG) provides information about an unconscious process and is presented visually on a computer screen, giving the patient immediate knowledge of muscle function, enabling the patient to learn how to alter the physiological process through verbal and visual cues. This mechanism allows the patient to assess muscle resting tone, creating an environment that teaches how to downtrain a tense pelvic floor while providing the means to teach co-ordination of muscle function.

In short, biofeedback treatment/training using the proper instrumentation provides the precise information necessary to change behaviors associated with tensing the pelvic floor for defecation instead of the proper relaxation of the pelvic floor for release of stool from the anal canal.

The Herman Wallace Course on Biofeedback Training for Pelvic Muscle Dysfunction provides the clinician with the proper treatment technique to use in the clinic to rehabilitate patients with pelvic floor muscle dyssynergia. Learning the proper use of biofeedback equipment and understanding the components to treating these challenging patients successfully is an essential component to this course. The clinician will learn numerous ways to teach this challenging patient population how to make this muscle function as intended, providing the patient with successful strategies for improved patient outcomes.

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Upcoming Continuing Education Courses

Pediatric Incontinence - Duluth, MN (Postponed)

Oct 23, 2020 - Oct 25, 2020
Location: Polinsky Medical Rehabilitation Center

Pediatric Incontinence and Pelvic Floor Dysfunction- Remote Course (SOLD OUT)

Oct 23, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Parkinson Disease and Pelvic Rehabilitation - Remote Course

Oct 23, 2020 - Oct 24, 2020
Location: Short Form Remote Course

Pelvic Floor Level 2A - Braintree, MA Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Peak Physical Therapy

Pelvic Floor Level 2A - New York, NY Satellite Location (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: 5 Point Physical Therapy

Pregnant and Postpartum Rehabilitation Special Topics - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Washington DC (POSTPONED)

Oct 24, 2020 - Oct 25, 2020
Location: George Washington University Hospital Outpatient Rehabilitation Center

Pelvic Floor Level 1 - Troy, NY Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: The Green Room Physical Therapy

Pelvic Floor Level 2A - Atlanta, GA (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 2A - Greenville, SC Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Restore Pelvic Health and Wellness

Pelvic Floor Level 1 - Self-Hosted

Oct 24, 2020 - Oct 25, 2020
Location: Self-Hosted Course

Peripartum Advanced Topics - Somerset, NJ (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Sports Medicine Institute

Pelvic Floor Level 2A - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Washington DC Satellite Location (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: George Washington University Hospital Outpatient Rehabilitation Center

Pelvic Floor Level 2A - Minnetonka, MN Satellite Course (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: Viverant

Pelvic Floor Level 2A -Decatur GA Satellite Course (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 2A - East Norriton, PA Satellite Course

Oct 24, 2020 - Oct 25, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 1 - Satellite Lab Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Akron, OH Satellite Location (Sold Out)

Oct 24, 2020 - Oct 25, 2020
Location: Summa Health Center

Pelvic Floor Level 2A - Self-Hosted

Oct 24, 2020 - Oct 25, 2020
Location: Self-Hosted Course

Pelvic Floor Level 2A - Athens, GA Satellite Course (Rescheduled)

Oct 24, 2020 - Oct 25, 2020
Location: Thrive Integrative Medicine

Pelvic Floor Level 2A - Tampa, FL Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Optimal Performance and Physical Therapies

Pelvic Floor Level 2A - Monroe, LA Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Ouachita Physical Therapy

Manual Therapy Techniques for the Pelvic Rehab Therapist - Atlanta, GA (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 1 - Goodyear, AZ Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: STI Physical Therapy & Rehab

Breastfeeding Conditions - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Akron, OH (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Summa Health Center

Manual Therapy for the Abdominal Wall - Remote Course (Postponed)

Oct 25, 2020
Location: Short Form Remote Course

Mobilization of the Myofascial Layer - Medford, OR Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Asante Rogue Valley Medical Center