Anorectal biofeedback

Domain IX · Biomedical, neuro & digital

What it is

Anorectal biofeedback is a behavioural retraining treatment for certain bowel-control and bowel-emptying problems, chiefly dyssynergic defecation (the pelvic floor and anal muscles tighten instead of relaxing when the person tries to open their bowels) and faecal incontinence. It is a specialist…

Format

• Education session(s). Explanation of normal anatomy and of the person's own pattern, toileting posture and behaviour. Goal: understanding and engagement.
• Home practice between sessions, as set by the clinic.

Who practises it, and how they are trained or regulated

• Training sessions. Customised, typically about an hour, often every two weeks; around four to six for dyssynergic defecation and about six for faecal incontinence, with possible later reinforcement sessions whose value is unclear. Children in trials had up to six. Office-based and home-based training are both used.
• Anorectal biofeedback is a behavioural retraining treatment for certain bowel-control and bowel-emptying problems, chiefly dyssynergic defecation (the pelvic floor and anal muscles tighten instead of relaxing when the person tries to open their bowels) and faecal incontinence. It is a specialist gastroenterology and pelvic-health procedure, usually delivered by nurse therapists or physiotherapists (in trials also…
• This guide is written for the psychotherapist working alongside the clinic. The clinic delivers the biofeedback; the psychotherapist's work is referral, preparation, managing shame, anxiety and trauma responses, supporting consent and adherence, coordinating with the team and integrating psychological care for functional bowel disorders. Procedure details are described only at the level of what a client can expect,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• catastrophic predictions; note them for B6.
• giving technique advice; discouragement after a bad week.
• psychological work being used to dismiss physical symptoms.
• reassurance-seeking from you instead of medical review; do not diagnose.
• breath-holding and bracing, which can also be trauma or anxiety responses.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.