Biofeedback, once the treatment of choice in ODS has taken a back seat. I personally found it ineffective in the presence of anatomical abnormalities after trying it in many patients over a 10 years period. Some clinicians over diagnose anismus or pelvic dyssynergia and consequently still offer biofeedback to many patients who [in my opinion] should be treated with irrigation or surgery.

Biofeedback still has a place in patients with anismus, solitary rectal ulcer syndrome, patients with strong ingrained poor defaecatory habits and postoperatively in patients with inadequate response to surgery [when it is clear that there was a good correction of anatomical abnormalities].

Pelvic floor excercises do not harm & may be useful in patients with faecal leakage secondary to incomplete evacuation [and in patients with leakage from other causes]. I do not recommend it as an intial treatment for ODS, but it still has a role to play