Changes in Psychological States During Instrumented Biofeedback for Dyssynergic Defaecation and Fecal Incontinence Are Associated With Changes in Patient‐Reported Outcomes

BACKGROUND: Chronic constipation and fecal incontinence (FI) are severe and chronic conditions associated with reduced quality of life and distress for those affected. Instrumented anorectal biofeedback has demonstrated efficacy in both conditions and is often described as a learning process, suggesting efficacy is mediated via central cognitive and motivational pathways, but empirical evidence is lacking. The aim of this exploratory study was to seek evidence of change in psychological processes as central mediators of biofeedback treatment efficacy. METHODS: Patients (n = 135) were prospectively recruited from a tertiary care hospital, diagnosed with constipation likely due to dyssynergic defecation and/or FI. A range of psychological traits covering cognitive processes, emotion regulation, and others were measured at the beginning and end of therapy, along with patient outcomes. Changes in psychological traits were correlated with corresponding changes in patient outcomes, including condition-specific quality of life measures. RESULTS: Improvement in constipation impact on quality of life was most notably correlated with reduced external locus of control (p = 0.004) and reduced use of acceptance as an emotion regulation strategy (p = 0.048). Correlates of improvement in FI impact on quality of life were also related to reduced use of acceptance as well as improvements in measures of executive function (p = 0.0003 to p = 0.03), cognitive flexibility (p = 0.0001 to p = 0.02), and emotional regulation (p = 0.002 to 0.045). CONCLUSIONS: Our data strongly support the hypothesis that improvements in the disease impact of constipation and FI during biofeedback are related to concomitant changes in central psychological processes, suggesting that psychological factors play an important part in the mechanism of action of biofeedback therapy.