Randomized controlled trial of biofeedback for fecal incontinence.
OBJECTIVE
Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care.


METHODS
A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry.


RESULTS
Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment.


CONCLUSIONS
Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education.
St. Mark's Hospital, Northwick Park, Watford Road, Harrow HA 1 3UJ, England, UK. csnorton@aol.com
Christine
C
Norton
Sonya
S
Chelvanayagam
Jenifer
J
Wilson-Barnett
Sally
S
Redfern
Michael A
MA
Kamm
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology; D001676:Biofeedback, Psychology; D003376:Counseling; D003672:Defecation; D003863:Depression / Q000209:etiology / Q000523:psychology; D004576:Electromyography; D005081:Exercise Therapy; D005242:Fecal Incontinence / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011788:Quality of Life; D016896:Treatment Outcome