Can biofeedback therapy improve anorectal function in fecal incontinence?
BACKGROUND
Although biofeedback treatment ameliorates symptoms in patients with fecal incontinence, whether it improves anorectal function is unclear.


OBJECTIVE
To examine prospectively whether biofeedback therapy influences objective and subjective parameters of anorectal function and whether it improves outcome.


METHODS
Nineteen consecutive patients (females = 17) with fecal incontinence for over 1 year, underwent a three-phase outpatient treatment program. This program consisted of pelvic muscle strengthening exercises (phase 1), 1-h biofeedback therapy sessions twice a week (phase 2), and reinforcement sessions at 6 wk, 3, 6, and 12 months (phase 3). The number of sessions in phase 2 were customized for each patient. Anorectal manometry, saline continence test, prospective stool diaries, and bowel satisfaction scores were used to assess the changes in bowel function before and 1 year after therapy.


RESULTS
After biofeedback therapy, the anal squeeze sphincter pressure (p < 0.05), the duration of squeeze (p < 0.001), and the capacity to retain liquids (p < 0.05) increased. Rectoanal coordination also improved with a reduction (p < 0.001) in rectal pressure and an increase (p < 0.05) in the continence index. Threshold volumes for first perception and desire to defecate decreased (p < 0.05). The number of therapy sessions varied, mean (range) = 7 (4-13). Stool frequency and the number of incontinence episodes decreased (p < 0.001). Bowel satisfaction score improved (p < 0.001).


CONCLUSIONS
Biofeedback therapy is effective and improves objective and subjective parameters of anorectal function in patients with fecal incontinence. Customizing the number of sessions and providing periodic reinforcement may improve the success rate.
Rao
S S
SS
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.
Welcher
K D
KD
Happel
J
J
D001003:Anal Canal / Q000503:physiopathology*; D001676:Biofeedback, Psychology; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000503:physiopathology* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome