title: Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy.
abstract: OBJECTIVE
  Excessive stool frequency and incontinence after anterior resection (AR) or total colectomy (TC) can be refractory to expectancy and antidiarrheal agents. We prospectively assessed efficacy of anorectal biofeedback therapy (BF) in this clinical situation.
  
  
  METHODS
  Thirteen patients (10 men and 3 women; mean age, 62.1 (standard error of the mean (SEM), 4.6) years) had more than six bowel movements per day and/or episodes of incontinence, which did not abate after antidiarrheal agents were given for at least six (mean, 27.9 (SEM, 6.3)) months after surgery. All underwent four sessions of outpatient BF. Assessment was by continence questionnaire and anorectal physiology tests, which were administered before and after BF.
  
  
  RESULTS
  In seven AR patients, daily stool frequency was decreased (8.7 (SEM, 2.1) before and 4.6 (SEM, 1.2) after, P < 0.05), and daily incontinence episodes were reduced (2.7 (SEM, 0.9) before and 0.4 (SEM, 0.2) after, P < 0.05) after BF. Six TC patients also had decreased daily stool frequency (6.2 (SEM, 2.1) before, 3.3 (SEM, 1.6) after; P < 0.05) and incontinence episodes (2.4 (SEM, 0.9) before, 0.5 (SEM, 1) after; P < 0.05) after BF. There were no significant changes in anorectal physiology parameters after BF. At a mean follow-up of 10.6 (SEM, 2.5) months after BF, there were no regressions or complications.
  
  
  CONCLUSIONS
  BF is a safe and effective option for refractory excessive stool frequency and/or incontinence following AR or TC.
authors.affiliation: Department of Colorectal Surgery, Singapore General Hospital, Singapore.
authors.forename: Y H
authors.initials: YH
authors.lastname: Ho
authors.forename: J M
authors.initials: JM
authors.lastname: Chiang
authors.forename: M
authors.initials: M
authors.lastname: Tan
authors.forename: J Y
authors.initials: JY
authors.lastname: Low
mesh_terms: D001676:Biofeedback, Psychology; D003082:Colectomy; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome