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การรักษาด้วยวิธี biofeedback therapy หรือการฝึกเบ่งเป็นวิธีมาตรฐานและเป็นการรักษาเฉพาะสำหรับความผิดปกตินี้ โดยมีหลักการคือ การฝึกให้กล้ามเนื้อที่เกี่ยวข้องกับการเบ่งทำงานประสานกันอย่างถูกต้อง โดยฝึกกล้ามเนื้อหน้าท้องให้เกิดแรงเบ่งที่เพียงพอขณะเดียวกันกับที่มีการคลายตัวของหูรูดทวารหนัก เพื่อให้แรงเบ่งที่เกิดขึ้นเอาชนะแรงต้านบริเวณหูรูดได้ โดยผู้ป่วยรับรู้ผลการทำงานของกล้ามเนื้อดังกล่าวผ่านเครื่อง anorectal manometry หรือ electromyography(EMG) ซึ่งจะแสดงผลออกเป็นภาพโดยมีแพทย์หรือพยาบาลผู้ฝึกคอยแนะนำ การฝึกแต่ละครั้งอาจใช้เวลาประมาณ 30-45 นาที และจำนวนครั้งที่ฝึกขึ้นกับความพึงพอใจของผู้ป่วย ทั้งนี้ผู้ป่วยที่มีปัญหาด้านความจำ ปัญหาทางจิต และผู้ป่วยที่มีปัญหาทางการสื่อสารอาจเป็นข้อจำกัดต่อการรักษาด้วยวิธีนี้
การศึกษาในระยะหลังพบว่าผู้ป่วย dyssynergic defecation จะมีการเปลี่ยนแปลงของ anorectal cortical function (gut-brain axis) โดยมี impair ano-cortical และ recto-cortical evoked potentials โดยผลของ biofeedback ต่อ brain-gut axis ยังเป็นที่ต้องศึกษาต่อ อย่างไรก็ตามการศึกษาแบบ RCT ในผู้ป่วย dyssynergic defecation โดย Rao และคณะ พบว่า biofeedback therapy มีประสิทธิภาพสูงกว่าการใช้ยาระบายร่วมกับการปรับพฤติกรรมและสูงกว่า sham biofeedback อย่างมีนัยสำคัญทางสถิติ ทั้งด้านความพอใจในการถ่าย จำนวนครั้งที่สามารถถ่ายอุจจาระได้เอง colonic transit time และballoon expulsion time
ในประเทศไทย ข้อมูลของโรงพยาบาลจุฬาลงกรณ์พบว่าประมาณ 40% ของผู้ป่วยท้องผูกเรื้อรังมีสาเหตุจากการเบ่งไม่ถูกต้องนี้และพบว่า biofeedback therapy สามารถทำให้ผู้ป่วยมีความพอใจในการถ่ายได้ถึง 60% อาการอืดแน่นท้อง ปวดท้อง การใช้ยาระบายลดลงอย่างมีนัยสำคัญทางสถิติ ทั้งนี้ไม่พบว่าอายุ การศึกษา ระยะเวลาที่เป็น การมีอาการของลำไส้แปรปรวนร่วมด้วยจะมีผลต่อการตอบสนองการรักษา โดยจำนวนครั้งที่ฝึกได้ผลประมาณ 1-3ครั้งและผู้ป่วยส่วนใหญ่มักตอบสนองในระยะยาว ในผู้ป่วยที่มีลำไส้ใหญ่เคลื่อนไหวช้าร่วมด้วยหรือผู้ป่วยที่มี impair rectal sensationจะตอบสนองต่อการรักษาไม่ดี โดยกลุ่มที่มีลำไส้ใหญ่เคลื่อนไหวช้าอาจจำเป็นต้องได้รับยาระบายต่อแม้เบ่งถูกต้องแล้ว
จะเห็นได้ว่าการสืบหาสาเหตุของอาการท้องผูกเรื้อรังโดยเฉพาะในรายที่รบกวนคุณภาพชีวิตของผู้ป่วยจะเป็นประโยชน์อย่างยิ่ง เนื่องจากหากพบว่ามีสาเหตุจากการเบ่งที่ไม่ถูกต้องแล้ว การรักษาด้วย biofeedback therapy จะได้ผลดีและมีจำนวนไม่น้อยที่หายขาดได้
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