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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.