The effect of biofeedback training on intestinal function among patients with middle and low rectal cancer: a randomized controlled study

Rectal cancer is a common colorectal carcinoma causing death in China, for which middle and low rectal cancer accounts for 60–80% of the total incidence (1-3). With development of medical technology and people’s higher requirements for the quality of life, many patients with rectal cancer of more than 2 cm between the neoplasm inferior margin and dentate line are able to have a sphincter preservation operation (SPO), so that the proportion of SPO takes up 62–85% in all rectal cancer operation (4,5). Although bowel continuity can be realized through SPO, the inconvenience and mental stress of neostomy nursing throughout life should be avoided, as approximately 90% of patients face bowel symptoms such as an increase of defecation times, endless defecation, or even fecal incontinence, which are collectively referred to as anterior resection syndrome (ARS), and cause serious disturbance to daily life (6-9). The life quality for some patients with SPO is similar to that of patients with Mile’s operation (5). At present, there is no specific therapy for ARS, and management is mainly based on experience and symptoms. Some researchers have reported the positive effect of drug use, anal plugging, rectal lavage, biofeedback training, and pelvic rehabilitation on rectal function (3,10). However, most research has focused on treatment after the occurrence of postoperative symptoms and adoption of self pre- and post-control, while few studies have reported on the indications and timing of ARS prevention and ARS treatment (11). Biofeedback (BFT) is an emerging type of biological behavior therapy which centers on applying a biofeedback mechanism to collect the physiological activity information of patients. This information is processed and amplified by special equipment, and displayed by using familiar visual or auditory signals, so that patients can adjust physiological activities according to their own information drawn from the physiological activities observed; in this way, abnormal physiological change can be relieved or eliminated (12). BFT is considered to be an effective, safe, noninvasive, and economic method with little adverse effect (13). The present study is a prospective randomized controlled trial that explores the effect of biofeedback training on middle and low rectal cancer patients with SPO by dynamic analysis on patients’ bowl function. The aim is to provide a practical basis for constructing reasonable rehabilitation training schemes of patients’ anorectal function