Gastroenterology - Biofeedback for Difficult Defaecation

This leaflet has 3 aims:

1. To help you become better informed and more involved in your care.
2. To explain what happens on the day of the procedure.
3. To answer some of the questions commonly asked about the procedure.

If you have any questions, access or communication needs such as an interpreter please contact the department stated on your appointment letter.

Please make sure that you read the following information.

The aim of your biofeedback training is to enable you to evacuate the bowel (rectum) more easily.

You may have a problem with the muscles of the pelvic floor, which causes the muscle in your back passage to tighten rather than relax when you attempt to go to the toilet for your bowels.

During the biofeedback training we will try to enable you to overcome this problem by retraining your muscles to relax when required.

• The series of recommendations should help you open your bowels easier with less straining
• There are no major risks associated with biofeedback, as with any treatment or test that requires a catheter to be inserted, there is a risk of perforation, however this very small
• These are limited to biofeedback that are ‘non-medical/non- surgical’

We will repeat the function test that you had at the start of the course of biofeedback so that we have before and after information.

You may find going to the toilet for your bowels easier if you follow the guidelines below:

Toilet position

Sitting in more of a ‘squatting’ position will aid going to the toilet to open your bowels in 2 ways. The first is that it makes the angle between your back passage and rectum ‘straighter’. The second is that it helps you to relax whilst trying to open your bowels as it’s harder to strain. Ask the physiologist undertaking your tests for a more detailed leaflet if you would like to give this a try.

Whilst sat on the toilet

You can use your breathing to help you go to the toilet. When you breathe you will notice that as you breathe in your body naturally rises, and as you breath out it naturally falls. You can use this to aid going to the toilet.

1. So, whilst sat on the toilet take a breath in, and as you breath out push down through your bottom as though you are widening your bottom.
2. Keep repeating until you have passed the motion. Try not to hold your breath.

Using your breathing is similar to yoga in that you take a breath in whilst preparing your ‘move’ and breathe out as you perform the exercise.

In addition, by ‘bracing’ the abdominal muscles whilst breathing in, then when breathing out push the muscles around your tummy area downwards, you can help the rectum empty more easily. If you are doing this correctly you will feel your waist area widen.

You can also imagine your bottom becoming ‘wider’ i.e. relaxing. This visualisation can help to evacuate, as many people with difficulty passing a motion often squeeze their bottom muscles rather than relax and they are not aware that they are doing this.

These movements will help the muscles in your pelvic floor relax and you should be aware of your back passage relaxing or opening and not tightening as you are doing the above.
 
Do not ‘strain’ for long periods of time as this may damage the muscle and nerves in the pelvic floor.

You may need to supplement your diet with foods or medication that will allow the contents of your bowel to be softer and so to allow easier elimination.

Increasing visits to the toilet

If you open your bowels infrequently, research has shown that sitting on the toilet at the same time each day for a few moments will speed up passage through your bowels. This is a long process, particularly if you have been constipated for many years. It is very important to stress that you are not forcing yourself to go to the toilet, so when you are sat on the toilet you are just sitting and breathing.