Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction

Br J Surg. 2008 Sep;95(9):1079-87. doi: 10.1002/bjs.6303.


Background: Pelvic floor dysfunction (PFD) is a type of functional constipation. The effectiveness of biofeedback as a treatment remains unclear.

Methods: A systematic review of all randomized controlled trials evaluating the effectiveness of biofeedback in adults with PFD was carried out. All online databases from 1950 to 2007 were searched. This was supplemented by hand searching references of retrieved articles.

Results: Seven trials fulfilled the inclusion criteria. Three compared biofeedback with non-biofeedback treatments and four compared different biofeedback modalities. Electromyography feedback was most widely utilized. The trials were heterogeneous with varied inclusion criteria, treatment protocols and definitions of success. Most had methodological limitations. Quality of life and psychological morbidity were assessed rarely. Meta-analysis of the studies involving any form of biofeedback compared with any other treatment suggested that biofeedback conferred a sixfold increase in the odds of treatment success (odds ratio 5.861 (95 per cent confidence interval 2.175 to 15.794); random-effects model).

Conclusion: Although biofeedback is the recommended treatment for PFD, high-quality evidence of effectiveness is lacking. Meta-analysis of the available evidence suggests that biofeedback is the best option, but well designed trials that take into account quality of life and psychological morbidity are needed.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Constipation / etiology
  • Constipation / psychology
  • Constipation / therapy*
  • Electromyography / methods
  • Feedback / physiology*
  • Female
  • Humans
  • Male
  • Manometry / methods
  • Middle Aged
  • Pelvic Floor / physiopathology*
  • Quality of Life*
  • Randomized Controlled Trials as Topic
  • Treatment Outcome