title: Adjuvant biofeedback following anal sphincter repair: a randomized study.
abstract: OBJECTIVE
  To evaluate the impact of adjuvant biofeedback following sphincter surgery.
  
  
  METHODS
  Thirty-eight patients were randomized into sphincter repair or sphincter repair plus biofeedback groups. Outcome measures included a symptom questionnaire, patient's rating of satisfaction with continence function and improvement, change in continence score, quality of life and anorectal physiology. Endoanal ultrasonography was also performed pre- and post-operatively.
  
  
  RESULTS
  Immediately following surgery, there was no statistically significant difference in any of the functional or physiological variables between the groups. Continence and patient satisfaction scores improved with a mean difference of -0.48 (95% CI: -3.30-2.33, P = 0.73) and 1.03 (95% CI: -1.40-3.46, P = 0.39), respectively. Only the difference in embarrassment scores reached statistical significance (mean) 0.56 (95% CI: 0.12-0.99, P = 0.014). Resting and squeeze pressures also improved. Thirteen of 14 in the biofeedback and 11 of 17 (control) reported symptomatic improvement. In the biofeedback group, although not statistically significant continence and satisfaction scores improved and were sustained over time. In the control group, continence and satisfaction scores changed little between 3 and 12 months (P = NS). Quality of life measures improved within the biofeedback group but there was no statistical difference between the groups.
  
  
  CONCLUSIONS
  Following surgery continence function improves in all patients but adjuvant biofeedback therapy improves quality of life and maintains symptomatic improvement over time.
authors.affiliation: Department of Surgery and Gastrointestinal Motility, St George's Hospital, London, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Davis
authors.forename: D
authors.initials: D
authors.lastname: Kumar
authors.forename: J
authors.initials: J
authors.lastname: Poloniecki
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D001004:Anus Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001676:Biofeedback, Psychology; D004724:Endoscopy / Q000379:methods; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012677:Sensation / Q000502:physiology; D016896:Treatment Outcome; D014463:Ultrasonography