Biofeedback as a Treatment of Fecal Incontinence or Constipation

When Policy Topic is covered Biofeedback for constipation in adults may be considered medically necessary for patients with dyssynergia-type constipation as demonstrated by meeting all 3 of the following criteria: 1. Symptoms of functional constipation that meet ROME III criteria (see Policy Guidelines). 2. Objective physiologic evidence of pelvic floor dyssynergia (see Policy Guidelines) demonstrated by inappropriate contraction of the pelvic floor muscles or less than 20% relaxation of basal resting sphincter pressure by manometry, imaging or EMG; 3. Failed a 3-month trial of standard treatments for constipation including laxatives, dietary changes, and exercises (as many of the previous as are tolerated).