(BQ) Part 2 book “Anorectal surgery” has contents: Biofeedback, functional anorectal disorders, anorectal malformations, fissure in ano, hemorrhoids, anorectal abscess, hidradenitis suppurativa, pilonidal sinus, rectal prolapse, feca incontinence, and other contents. | chapter Biofeedback 11 Dyssynergic defecation is one of the most common forms of functional constipation both in children and adults. It is defined as incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. Up to one half of patients with constipation suffer from the entity known as dyssynergic defecation. This is an acquired behavioral problem and is caused by the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. In the current scenario, it is possible to diagnose this problem through: • History • Prospective stool diaries • Anorectal physiologic tests. Biofeedback also known as neuromuscular training is: • The use of electronic or electromechanical equipment to measure • Provide information about specific physiologic functions • That can then be controlled in therapeutic directions. Neuromuscular training or biofeedback therapy is an instrumentbased learning process that is based on ‘‘operant conditioning’’ techniques. The goal of neuromuscular training using biofeedback techniques is to restore a normal pattern of defecation. A Standard Biofeedback Training Protocol The mainstay of behavior therapy is to first explain the anorectal dysfunction and discuss its relevance with the patient before approaching the treatment. Biofeedback 233 The next step includes training the patients on a more effective use of the abdominal muscles to improve pushing effort. Patients are next shown anal manometry or EMG recordings displaying their anal function and are taught through trial and error to relax the pelvic floor and anal muscles during straining. This objective is first pursued with the help of visual feedback on pelvic floor muscle contraction, accompanied by continuous encouragement from the therapist. When the patient has learned to relax the pelvic floor muscles during straining, the visual and auditory help are .
