title: Long-term outcome and objective changes of anorectal function after biofeedback therapy for faecal incontinence.
abstract: BACKGROUND
  In the short-term, biofeedback therapy improves symptoms and anorectal function in patients with faecal incontinence but whether there is long-term improvement is incompletely understood.
  
  
  OBJECTIVE
  To prospectively evaluate bowel symptoms and anorectal function, both immediately and 12 months after biofeedback therapy.
  
  
  METHODS
  A total of 105 consecutive patients (male/female = 12/93) with faecal incontinence, unresponsive to supervised medical treatment were enrolled in biofeedback training consisting of biweekly pelvic muscle strengthening exercises, anal squeeze and sensory-motor coordination training, and reinforcement sessions at 3, 6 and 12 months. Anorectal manometry, saline continence test, stool diaries and bowel satisfaction scores were used to assess improvement.
  
  
  RESULTS
  94/105 (male/female = 10/84) completed training and 11 dropped out. Sixty completed 1-year assessment. At 1-year, 63% reported no episodes of incontinence. Biofeedback decreased (P < 0.001) stool frequency and number of incontinence episodes and increased (P < 0.001) bowel satisfaction score, anal resting and squeeze pressures, squeeze duration and ability to retain saline infusion increased (P < 0.001), both immediately and at 1 year. Sensory thresholds decreased (P < 0.001).
  
  
  CONCLUSIONS
  Biofeedback therapy produced sustained improvement in bowel symptoms and anorectal function. Because it is safe, inexpensive compared with other surgical interventions, and effective, biofeedback should be offered to incontinent patients unresponsive to medical therapy.
authors.affiliation: Department of Internal Medicine, Section of Neurogastroenterology, Division of Gastroenterology-Hepatology, University of Iowa Carver College of Medicine, Iowa City, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ozturk
authors.forename: S
authors.initials: S
authors.lastname: Niazi
authors.forename: M
authors.initials: M
authors.lastname: Stessman
authors.forename: S S C
authors.initials: SS
authors.lastname: Rao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000502:physiology; D001676:Biofeedback, Psychology; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012007:Rectum / Q000502:physiology; D012677:Sensation; D016896:Treatment Outcome