Biofeedback Therapy Versus Botox Injection in Treatment of Dyssynergic Defecation.

Inclusion Criteria: * patients of both genders * age of 18 years or older * fulfillment of the Rome 3 constipation criteria for the past 3 months, symptom onset as a maximum six months prior to diagnosis, patients suffer from prolonged, incomplete and challenging evacuation Exclusion Criteria: * Anismus cases with secondary reason for constipation * patients who undergone anorectal surgery Patients with colonic inertia * conditions that make biofeedback training impossible * cases with primary illness causing constipation as hypothyroidism