Prospective trial of pelvic floor retraining in patients with fecal incontinence.
OBJECTIVE
Our aim was to prospectively evaluate pelvic floor retraining (PFR) in improving symptomatic fecal incontinence.


METHODS
PFR was used to treat 30 patients with fecal incontinence (28 women; age range, 29-85 (median, 68) years). PFR was performed by a physiotherapist in the outpatient department according to a strict protocol and included biofeedback using an anal plug electromyometer. Manometry (24 patients), pudendal nerve terminal motor latency (PNTML, 16 patients), and anal ultrasound (14 patients) were done before commencing therapy. Independent assessment of symptoms was done at the commencement of therapy, at 6 weeks, and at 6 and 12 months posttherapy.


RESULTS
Twenty patients (67 percent) had improved incontinence scores, with eight patients (27 percent) being completely or nearly free of symptoms. Of 28 patients followed up longer than six months, 14 achieved a 25 percent or greater improvement at six weeks, which was sustained in all cases. Fourteen had an initial improvement of less than 25 percent, with only four (29 percent) showing later improvement (P < 0.0001). There was no relationship between results of the therapy and patient age, initial severity of symptoms, etiology of incontinence, and results of anal manometry, PNTML, and anal ultrasound.


CONCLUSIONS
PFR is a physical therapy that should be considered as the initial treatment in patients with fecal incontinence. An improvement can be expected in up to 67 percent of patients. Initial good results can predict overall outcome.
Rieger
N A
NA
Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia.
Wattchow
D A
DA
Sarre
R G
RG
Cooper
S J
SJ
Rich
C A
CA
Saccone
G T
GT
Schloithe
A C
AC
Toouli
J
J
McCall
J L
JL
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000294:innervation / Q000503:physiopathology*; D001676:Biofeedback, Psychology; D002985:Clinical Protocols; D004576:Electromyography; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000294:innervation / Q000503:physiopathology*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011930:Reaction Time; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography