Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter in the early treatment of postpartum fecal incontinence.
OBJECTIVE
The purpose of this study was to compare intra-anal electromyographic biofeedback alone with intra-anal biofeedback that was augmented with electrical stimulation of the anal sphincter in the treatment of postpartum fecal incontinence. A secondary aim was to examine the impact of the treatment on continence-related quality of life.


METHODS
Sixty symptomatic women were assigned randomly to receive intra-anal electromyographic biofeedback or electrical stimulation of the anal sphincter once weekly for 12 weeks and to perform daily pelvic floor exercises between treatments. Therapeutic response was evaluated with a symptom questionnaire to determine continence score, anal manometry, and endoanal ultrasound scanning. Quality of life was assessed before and after treatment with a validated questionnaire.


RESULTS
Fifty-four women completed the treatment; 52 women (96%) had ultrasonic evidence of an external anal sphincter defect. After the treatment, both groups demonstrated significant improvement in continence score (P < .001) and in squeeze anal pressures (P < .04). Resting anal pressures did not alter significantly. Quality of life improved after the completion of physiotherapy, but there were no differences in outcome between intra-anal electromyographic biofeedback and electrical stimulation of the anal sphincter.


CONCLUSIONS
Intra-anal electromyographic biofeedback therapy was associated with improved continence and quality of life in women with altered fecal continence after delivery. The addition of electrical stimulation of the anal sphincter did not enhance symptomatic outcome.
Department of Obstetrics and Gynaecology, University College Dublin, Ireland.
Rhona T
RT
Mahony
Patricia A
PA
Malone
Judith
J
Nalty
Michael
M
Behan
P Ronan
PR
O'connell
Colm
C
O'herlihy
D000328:Adult; D001003:Anal Canal / Q000502:physiology*; D004599:Electric Stimulation Therapy; D004576:Electromyography / Q000379:methods*; D015444:Exercise; D005242:Fecal Incontinence / Q000628:therapy*; D005246:Feedback; D005260:Female; D006801:Humans; D010298:Parity; D017773:Pelvic Floor / Q000502:physiology; D026741:Physical Therapy Modalities; D011247:Pregnancy; D011312:Pressure; D011644:Puerperal Disorders / Q000628:therapy; D011788:Quality of Life; D011795:Surveys and Questionnaires