{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:12:10Z","timestamp":1793293930003,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T00:00:00Z","timestamp":1729814400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Functional defecation disorders (FDD) are a common etiology of refractory chronic constipation (CC). FDD diagnosis (dyssynergic defecation [DD] and inadequate defecatory propulsion [IDP]), requires diagnostic tests including anorectal manometry (ARM) and balloon expulsion test (BET). Biofeedback (BF) is the treatment of choice for DD. The aims of our study were to evaluate: the outcome of BF in a group of constipated patients with defecatory disorders of any etiology; the efficacy of two simple diagnostic tools in predicting BF outcome in the short\u2010term.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One hundred and thirty\u2010one refractory CC patients failing the BET underwent BF therapy. Before BF, all patients underwent the following:\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>ARM.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Straining questionnaire. The answers were: \u201cbelly muscles\u201d; \u201canal muscles\u201d; \u201cboth\u201d; \u201cDon't know\/No answer.\u201d<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Digital rectal examination augmented by abdominal palpation on straining (augmented\u2010DRE).<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p>The BF therapist was blinded to ARM, straining questionnaire, and augmented\u2010DRE results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Eighty\u2010one patients responded to BF. Gender, age, and IBS\u2010C showed no significant impact on BF response. Both DD and IDP responded equally to BF, while the rate of response in patients with isolated structural pelvic floor abnormalities was lower (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The answer \u201canal muscles\u201d to straining questionnaire showed a strong association with BF response (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). A lack in abdominal contraction and in anal relaxation on augmented\u2010DRE were strongly associated with BF response (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Absence of manual maneuvers to facilitate defecation was associated with BF response (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>BF is the therapy of choice for refractory constipation due to FDD of any etiology, inducing both clinical and anorectal physiology improvement in the short term. Comorbid IBS\u2010C did not affect outcome while symptomatic isolated pelvic floor abnormalities appeared refractory to behavior treatment.<\/jats:p><jats:p>The straining questionnaire and augmented\u2010DRE outcomes showed a strong correlation with BF response and can be implemented in clinical practice to improve the management of constipated patients by prompting early referral to BF.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14948","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T10:00:49Z","timestamp":1729850449000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Biofeedback efficacy for outlet dysfunction constipation: Clinical outcomes and predictors of response by a limited approach"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9565-5039","authenticated-orcid":false,"given":"Christian","family":"Lambiase","sequence":"first","affiliation":[{"name":"Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"},{"name":"NIHR Nottingham BRC Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Bellini","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6587-7602","authenticated-orcid":false,"given":"William E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"UNC Center for Functional GI and Motility Disorders University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan Lucian","family":"Popa","sequence":"additional","affiliation":[{"name":"2nd Medical Department Iuliu Ha\u021bieganu University of Medicine and Pharmacy  Cluj\u2010Napoca Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Morganti","sequence":"additional","affiliation":[{"name":"Clinical Trial Statistical Support Unit Azienda Ospedaliero Universitaria Pisana  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Chiarioni","sequence":"additional","affiliation":[{"name":"UNC Center for Functional GI and Motility Disorders University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Medicine, Gastrointestinal Unit, Il Cerchio Med HealthCare Verona Center  Verona 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