• Reference Number: HEY-028/2023
• Departments: GI Physiology
• Last Updated: 1 September 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or would like further explanation, please call the Department of GI Physiology directly on 01482 624036.

What is Biofeedback Therapy?

You have recently been troubled by bowel symptoms (i.e. faecal incontinence and/or constipation). Following discussion with your doctor, they have advised that Biofeedback Therapy may help with your current bowel symptoms. 

Biofeedback Therapy focuses mainly on measurements taken from a procedure that measures the pressure of the muscles inside your bottom (anal canal and rectum). The treatment aims to help you re-train and regain control of these muscles, which should improve your symptoms of faecal incontinence and/or constipation.

Why do I need Biofeedback Therapy?

Biofeedback Therapy is used to try and improve bowel symptoms. It is often tried before considering a surgical procedure.

Can there be any complications or risks?

As with all procedures, there are some risks associated with Biofeedback Therapy. These include occasional minor discomfort, minor bleeding and, very rarely, perforation of the bowel wall.

However, the overall risk of having a problem when undergoing this specialist treatment (involving the pressure measurement procedure) is very low.

How do I prepare for Biofeedback Therapy?

Please read the information leaflet. If you wish, share the information it contains with your partner and / or family so that they can be of help and support.

You are asked to complete a bowel diary and questionnaire before your appointment. The bowel diary should be completed for 7 days prior to your appointment – if you have a short notice appointment, please complete as many days as possible. The instructions for completion are on the form.

You can eat and drink as normal and you will be able to resume your normal activities after your biofeedback session.

What will happen?

You should go to the Department of GI Physiology, which is situated next to Ward 14 (1st floor) at Castle Hill Hospital.

You will be seen by a member of staff from the Department of GI Physiology. At your first appointment, the healthcare professional will discuss your bowel symptoms with you and go through your completed questionnaire so that an appropriate Biofeedback Therapy programme can be tailored to your individual needs.

You will then be asked to remove your lower clothing and lay on your left side with your knees drawn up, on an examination couch. You will covered with a blanket as much as possible to protect your privacy and dignity.

The healthcare professional may then conduct a quick and simple examination of your anal canal and rectum before placing a small measurement probe into your bottom. The probe has a small balloon on the end, which can be used to mimic the sensations of wanting to go to the toilet. You will be asked to squeeze, cough and push down, to obtain accurate measurements of the muscles in your bottom. This will happen at each Biofeedback Therapy appointment.

At each appointment you will be shown the live pressure signals from the muscles in your bottom on a computer screen. The pressure signals will be explained to you and you will be coached through a series of targeted exercises. The probe may be in place for up to 30 minutes, including time for both the pressure measurements and targeted exercises.

You will be provided with information about exercises to practice at home. Depending on your bowel symptoms, you may also be provided with other lifestyle and/or dietary advice. It is important that you do your exercises as set out at your first appointment on a daily basis. Improvement will only be possible if you are well motivated and prepared to work at your exercises.

The first appointment may take up to 2 hours in total. You will then have two further follow-up appointments, approximately 6 weeks apart (allowing 12 weeks in total for the Biofeedback Therapy programme). The two follow-up appointments will take approximately 1 hour each. At each appointment the probe will be placed in your bottom so you can practice the targeted exercises using the computer screen. This will also allow us to measure any improvements. You will be asked to complete a review questionnaire at home prior to each of your two follow-up Biofeedback Therapy appointments. However, the majority of the work will be done by you outside of your hospital appointments.

It is very important that you continue with the Biofeedback Therapy exercises and attend your follow-up appointments for the treatment to work. Patients who do not attend appointments without notification will be withdrawn from the Biofeedback Therapy programme and discharged from the department.

What will happen afterwards?

You will be given some information to take away and read which contains the exercises discussed at your appointment.

You will have regular hospital appointments but the majority of the work will be done by you outside of your hospital appointments. It is important that you do your exercises as set out at your first appointment on a daily basis – improvement will only be possible if you are well motivated and prepared to work at your exercises.

You will be assessed at 3 monthly intervals in order to determine improvement. You will be offered advice on ways to try and help manage your symptoms and where appropriate will be given information leaflets. Any improvement may take quite a while to notice.

It is very important that you continue with the biofeedback therapy exercises for the treatment to work and attend your follow-up appointments. Patients who do not attend appointments without notification will be withdrawn from the programme. You will be given a follow-up appointment after each visit if appropriate.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Department of GI Physiology on telephone (01482) 624036.

This leaflet was produced by the Department of GI Physiology, Hull University Teaching Hospitals NHS Trust and will be reviewed in 3 years

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.