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:
Symptoms of functional constipation that meet Rome IV criteria (see Policy Guidelines section).
Objective physiologic evidence of pelvic floor dyssynergia (see Policy Guidelines section) demonstrated by inappropriate contraction of the pelvic floor muscles or less than 20% relaxation of basal resting sphincter pressure by manometry, imaging, or electromyography;
Failed a 3-month trial of standard treatments for constipation including laxatives, dietary changes, and exercises (as many of the previous as are tolerated).
Biofeedback is considered investigational as a treatment of constipation in adults and children in all other situations.
Biofeedback is considered investigational as a treatment of fecal incontinence in adults and children.
