Heymen 1999.

Methods	Study design: randomised controlled trial Total study duration: no follow‐up beyond end of treatment
Participants	36 patients referred to tertiary centre with pelvic floor dyssynergia, who required laxatives, enemas, digitation or combination to achieve bowel movement (26 female, 10 male) gender split between groups was not reported Age ‐ mean 61 years (range 18 to 82 years); duration of symptoms not reported Baseline comparability not reported
Interventions	Randomised to four groups All patients in intervention and comparison groups also educated as to normal bowel function, posture, not to prolong defecation attempts beyond 10 to 15 minutes, not to strain and to schedule bowel movements after meals or exercise Intervention group: Group 1: Weekly one hour  EMG biofeedback ‐ use of intra‐anal sensor with EMG display of muscle activity Comparison groups: Group 2. EMG biofeedback plus balloon distention sensory training (using flexible manometry catheter with balloon attached and inflated up to 140 mL) 3. EMG biofeedback plus home trainer EMG biofeedback unit 4. EMG biofeedback plus balloon distention sensory training plus home trainer EMG biofeedback unit
Outcomes	Change in frequency of unassisted bowel movements (UBM) (meaning of UBM not defined) Laxative use
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not reported
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding (performance bias and detection bias) All outcomes	High risk	Not blinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	No attrition reported
Selective reporting (reporting bias)	Unclear risk	Not registered on a clinical trials registry
Other bias	High risk	Primary outcome was assessed by unblinded therapist making contact with patients by telephone