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.
Norton
Christine
C
St. Mark's Hospital, Northwick Park, Watford Road, Harrow HA 1 3UJ, England, UK. csnorton@aol.com
Chelvanayagam
Sonya
S
Wilson-Barnett
Jenifer
J
Redfern
Sally
S
Kamm
Michael A
MA
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