4. Original study

Anorectal biofeedback is an established method for the therapy of defecation disorders. However, contradictory data are reported with respect to results and sustainability of the results [18–20]. Given the possibility to work in the busiest center of gastrointestinal motility in our country, we aimed to evaluate the value of the anorectal biofeedback. Impressed by the fact that many patients included in our biofeedback program dropped out, we wanted to look for reasons of failure. Therefore, we analyzed cases of patients submitted to anorectal biofeedback, stratified on presentation and etiology of the medical condition and recorded success or failure, as well as reasons for these outcomes.

#### 4.1. Methods

This was a prospective study conducted in a tertiary medical center with interest in functional and motility disorders; it is the single center in this country performing the anorectal biofeedback.

As subjects, we included in this study 20 patients. Eight of them presented with anal incontinence (2 males, 6 females, aged 46–71 years, median 55 years) and twelve patients with terminal constipation (6 males, 6 females, aged 58–78 years, median 67 years). All constipated patients presented only terminal constipation and not transportation constipation. The patients with anal incontinence were functional: 6 cases, or organic: 6 cases (2 after vaginal delivery, 1 after medullar trauma, 2 because of neuropathy). All these patients expressed their informed consent. The study was carried out according to the ethical criteria respected in any human research. They were included after anorectal manometry because conventional therapy was not helpful. Exclusion criteria were represented by the refuse to participate and contraindication to biofeedback. The biofeedback procedure was according to the description of the abovementioned methods. The constipated patients have previously been investigated for colonic transit with radiopaque pellets, and the results were normal in every case. Biofeedback sessions were scheduled twice per week for 2–3 months followed by monthly sessions for another 3–6 months. This rhythm is different from the rhythm described above, but we wanted to have more rapid results and to test the role of such intensive procedure. Patients were advised to repeat daily at home the exercises even in the absence of equipment for biofeedback. Following parameters were investigated (Table 1).

All these parameters were evaluated by a qualitative method based on interviews with the patients and using a structured interview appropriate for their understanding.

Descriptive statistics were used according to a commercial package.
