Constipation is one of the most typical gastrointestinal complaints worldwide. While it may seem like a minor problem, chronic constipation can significantly affect a person’s quality of life. People often depend on over-the-counter laxatives to ease their symptoms, but newer therapies like biofeedback have emerged as effective long-term solutions. As a Gastro physiologist and Biofeedback Specialist in Pune, India, Dr. Rupali Bandgar-Jankar believes it is important to understand the difference between these two approaches to choose the best treatment tailored to each patient’s needs.

What is Constipation?

Constipation is generally defined as having fewer than three bowel movements a week, hard or lumpy stools, excessive straining, or a feeling of incomplete evacuation. Causes can range from dietary deficiencies (low fiber intake), dehydration, lack of exercise, medications, and hormonal changes, to more complex issues like pelvic floor dysfunction or slow colon transit.

The Traditional Choice: Laxatives

Laxatives are usually the first line of treatment for constipation. They include:

• Bulk-forming laxatives (e.g., psyllium husk), which add fiber and improve stool bulk.
• Stool softeners (e.g., docusate) that moisten the stool, making it easier to pass.
• Osmotic laxatives (e.g., polyethylene glycol, lactulose) that draw water into the intestines to soften stools.
• Stimulant laxatives (e.g., bisacodyl, senna) promote bowel contractions.

Pros of Laxatives:

• Quick relief: Laxatives can work within hours to a day, depending on the type used.
• Easy availability: They are easily available without a prescription.
• Affordable: Most are low-cost options for immediate relief.

Cons of Laxatives:

Despite these advantages, laxatives have significant drawbacks, particularly when used long-term:

• Dependency: Chronic use can lead to the bowel becoming ‘lazy’, resulting in worsening constipation when stopped.
• Side effects: Cramping, bloating, gas, and electrolyte imbalances can happen.
• Mask underlying problems: Laxatives treat the symptom but do not address the root cause, such as pelvic floor dysfunction or anorectal coordination issues.
• Tolerance development: Over time, higher doses may be needed to reach the same effect.

The Modern Alternative: Biofeedback Therapy

Biofeedback is a non-invasive, drug-free therapy used to treat constipation caused by pelvic floor dysfunction or dyssynergic defecation (inability to coordinate abdominal and pelvic muscles during stool passage). It uses sensors to measure muscle activity and provides real-time visual or auditory feedback to help patients learn how to relax and coordinate their pelvic floor muscles effectively.

How Does Biofeedback Work?

At Kaizen Gastro Care, biofeedback therapy involves:

• Assessment: An initial evaluation to diagnose the exact cause of constipation using tests like anorectal manometry or balloon expulsion test.
• Training sessions: Patients are taught to:
• Relax the anal sphincter.
• Coordinate abdominal pushing with pelvic relaxation.
• Improve rectal sensation.
• Feedback monitoring: Visual graphs or auditory cues guide patients to correct their technique.

Typically, 4-6 sessions are required for optimal results, with each lasting around 30-45 minutes under specialist supervision.

Pros of Biofeedback Therapy:

• Addresses root cause: Unlike laxatives, biofeedback corrects the underlying issue of pelvic floor dyssynergia.
• Long-lasting results: Studies show success rates of 70-80% with benefits lasting for years.
• No medication side effects: Completely drug-free and safe for all age groups.
• Improved bowel coordination: Enables patients to relearn normal defecation dynamics.
• Improves quality of life: Decreases dependency on medications and prevents complications from chronic constipation.

Cons of Biofeedback Therapy:

• Availability: Requires specialized equipment and trained professionals, not available everywhere.
• Time investment: Requires multiple sessions and patient commitment.
• Cost: May be higher upfront compared to a course of laxatives, but cost-effective long-term by lowering future treatments and hospital visits.

Which is Better: Laxatives or Biofeedback?

Both treatments have their place in constipation management. The choice relies on the cause and severity of constipation.

• For occasional constipation due to dietary changes, stress, or travel, laxatives can provide quick relief when lifestyle measures (increased fiber, water intake, exercise) fail.
• For chronic constipation due to pelvic floor dysfunction, biofeedback therapy is superior to laxatives. It treats the functional issue, whereas laxatives only push stools out temporarily without correcting the muscle coordination issue.
• For slow transit constipation (where colon movements are sluggish), biofeedback has a limited role, and treatment focuses on dietary management, osmotic laxatives, and sometimes newer drugs like prucalopride.

What Does Research Say?

Studies have repeatedly shown that:

• Biofeedback therapy has a higher success rate (up to 80%) in treating dyssynergic defecation compared to laxatives alone.
• Laxatives are ineffective in pelvic floor dysfunction because the problem is not stool consistency but muscle coordination.
• Combining dietary modifications, lifestyle changes, and biofeedback offers the best outcomes in chronic constipation.

Dr. Rupali Bandgar-Jankar's Approach:

At Kaizen Gastro Care, Dr. Rupali Bandgar-Jankar emphasizes:

• Accurate diagnosis first: Before starting any therapy, determining the root cause is important.
• Tailored treatment plan: Not every patient benefits from laxatives alone. If anorectal dysfunction is identified, biofeedback is suggested as first-line therapy.
• Patient education: Understanding bowel mechanics, diet, hydration, and toilet posture is integral to successful treatment.

Conclusion:

While laxatives provide short-term relief, they are not a long-term solution for many forms of constipation, particularly when the cause is muscle coordination issues. Biofeedback therapy offers a safe, effective, and lasting option by addressing the underlying problem. If you suffer from chronic constipation unresponsive to laxatives, consult a specialist trained in gastrointestinal motility and biofeedback therapy. At Kaizen Gastro Care, Dr. Rupali Bandgar-Jankar and her team are dedicated to identifying the cause of your constipation and guiding you toward a treatment that offers real and lasting relief.