Biofeedback therapy, an instrument-guided behavioral therapy through which an individual learns how to modify their abnormal physiology and improve physical health, has been recommended as an effective therapy for these disorders. Randomized controlled trials (RCT) have shown that biofeedback therapy effectively improves dyssynergic defecation in 70% of patients and in 65% of patients with FI, as well as over 80% of patients with levator ani syndrome. Biofeedback is more effective than Kegel exercises in patients with FI. Recently, in RCTs using barostat-assisted balloon techniques sensory biofeedback therapy also improves rectal hypersensitivity (69%) and rectal hyposensitivity (78%). A critical barrier to progress in this field is that no umbrella organization is dedicated to physiological testing and biofeedback therapy for anorectal disorders, especially to provide optimal care, education/training, and monitoring treatment. Although some physical/behavioral therapists, gastroenterologists, and nurse clinician specialists have conducted research, education, and training, a lack of cohesive approach leads to a patchwork of care and services, nationally and globally. Consequently, there is a lack of standardization in technique, or even a consensus on technique, so patients are left to fend for themselves.

Also, most healthcare providers have limited knowledge about biofeedback therapy, especially if these services are available locally or regionally, what its benefits are, who provides them, who are qualified and trained personnel, and how and where to refer patients. Also, biofeedback protocols, equipment, and training, and education are not standardized. For instance, the standard method of administering Office-Biofeedback Therapy (OBT), consists of placing a probe in the rectum connected to a pressure/EMG recorder and a monitor for displaying the waveforms. However, this was not designed for biofeedback but adapted from diagnostic anorectal manometry. Consequently, they are not practical or user-friendly tools for patients to understand their dysfunction or correct their disordered bodily functions. Further, they are expensive and fragile and break down easily, imposing significant costs to patients and practitioners. There is a clear need for digital health-based biofeedback instruments that are patient-friendly, inexpensive, provide realistic feedback and can be administered at home or in office or via tele-health monitoring by well-trained biofeedback therapists, both in physical therapy and within GI practice settings.

Further, there is currently no organization or society dedicated to the training, quality improvement or promotion of biofeedback therapy for clinical practice or research, limiting the growth and advancement of this field. Some therapists actively involved in biofeedback research or practice mainly pursue these efforts independently. Furthermore, there are no resources for institutions wishing to develop a biofeedback therapy programs or for gastroenterologists interested in referring to behavioral providers with this expertise. Finally, there is no resource for providers to access a directory to identify practitioners providing these treatments.

We wish to create an international anorectal biofeedback section (ABS) to fulfill this gap and unmet need. A central organization dedicated explicitly to biofeedback will advance the field by encouraging clinical and research collaboration and increasing the visibility of biofeedback therapists in GI and physical therapy. This will promote evidence-based biofeedback treatments for patients with anorectal disorders and ultimately improve patient care.

The Goal of the ABS will be to increase the knowledge of the causes, identification, treatment, and care of patients with pelvic floor anorectal disorders

• Survey biofeedback therapists (physicians, physical therapists, behavioral therapists, Nurses) who perform biofeedback therapy in USA, Europe, Australia, and other potential countries to learn current first-hand practices of biofeedback therapy (see survey enclosed)
• Develop a comprehensive, searchable provider directory (list serve/emails) for any healthcare provider wishing to refer to biofeedback services, statewide, regionally and internationally
• Facilitate the development of standard terminology, indications, and protocols for performing biofeedback therapy
• Increase awareness of the previously poorly recognized rectal hypersensitivity and hyposensitivity and facilitate educational programs to diagnose and treat them.  These diagnoses are will be added to Rome V.
• Promote the use of evidence-based behavioral treatments for anorectal disorders internationally
• Encourage the development of interdisciplinary biofeedback therapy programs in gastroenterology and physical therapy practices through expert consultation and lectureships
• Connect with national and international GI organizations to enhance the visibility of biofeedback therapy and encourage collaboration
• Improve physician and patient access to biofeedback services
• Expand our field into previously under-studied areas of biofeedback therapy.  This includes bloating and abdominal distension, abdomino-phrenic dyssynergia, GERD and other complex anorectal disorders amenable to such therapies.