Download BEHAVIOURAL THERAPY FOR CHRONIC CONSTIPATION

BEHAVIOURAL THERAPY FOR CHRONIC CONSTIPATION
INTRODUCTION: Chronic constipation affects up to 20% of the Australian population and is often
unresponsive to traditional conservative and drug therapies. Behavioural therapy (BT), often known
as “biofeedback”, has been shown to be effective. We investigated the effect of BT on patient’s
subjective well-being, symptoms, laxative use, and physical and mental quality of life.
METHODS: Patients who had failed standard care for constipation underwent BT in a private
specialist clinic. Severity of physical symptoms and quality of life were assessed before and after
therapy, using a standardised “constipation scoring system” (CSS) and SF-36 questionnaires. The
primary outcome measure was the patient’s subjective perception of improvement. Secondary
outcome measures were symptoms related to constipation and quality of life scores.
RESULTS: Two hundred and thirty-three consecutive patients had intractable constipation of
which BT was completed in 180 (77%) over 3 (median) sessions. Subjective improvement in
constipation was reported in 165 (92%) patients. Up to 70% of patients derived positive benefit in
all CSS domains. Symptoms of abdominal pain and bloating were ameliorated in greater than 80%
of patients. SF-36 physical and mental composite scores improved by an average of 20 and 14
points respectively. Patients with longer duration of symptoms (>10 years) were more likely to drop
out from treatment. Concomitant functional incontinence and the need for digital evacuation were
negative predictors.
CONCLUSION: Behavioural therapy is associated with significant improvements in clinical
symptoms of chronic intractable constipation and enhanced quality of life, in patients resistant to
standard therapies. Non-drug therapies that successfully treat patients with resistant functional gut
disorders are needed in the mainstream provision of care.