Perineal retraining improves conservative treatment for faecal incontinence: a multicentre randomized study.
BACKGROUND
Anal incontinence is a frequent complaint that profoundly affects quality of life. Our aim was to determine whether perineal retraining gives additional benefits to standard medical treatment.


METHODS
Patients with anal incontinence and a Wexner score >4 were randomly assigned to standard conservative treatment (control) or perineal retraining, including biofeedback, in addition to standard treatments (biofeedback). Diaries, self-administered questionnaires and satisfaction scores quantified the benefits. Self-evaluated improvement was the primary outcome measure. A score ≥3 (in an improvement scale from -5 to +5) defined success.


RESULTS
Overall, 157 patients were included; 80 in the control group (75% females, mean age 60.1 ± 13.2 years) and 77 in the biofeedback group (79% females, mean age 61.9 ± 10.2 years). After a 4-month follow-up, the success rate was significantly higher in the biofeedback group (57% versus 37%; p<0.021). In the biofeedback group, daily stool frequency, leakage, and faecal urgency significantly decreased, and daily non-urgent perception of stool increased. Conversely, symptomatic scores and quality of life scales did not significantly differ between groups. In a multivariate model, the adjusted odds ratio showed that perineal retraining was significantly associated with a higher chance of self-rated improvement (adjusted Odd Ratio [95%CI]: 2.34 [1.14-4.80]; p=0.021).


CONCLUSIONS
Perineal retraining offers a moderate but significant benefit for patients suffering from anal incontinence.
Hospices Civils de Lyon, Digestive Physiology, Lyon, France.
Henri
H
Damon
CHU Rennes, Gastroenterology, and Rennes University, France. Electronic address: laurent.siproudhis@chu-rennes.fr.
Laurent
L
Siproudhis
CHU Grenoble, Digestive Surgery, and Grenoble University, France.
Jean-Luc
JL
Faucheron
CHU Nice, Gastroenterology, France.
Thierry
T
Piche
AP-HP, Bichat Hospital, Gastroenterology, Paris, France.
Laurent
L
Abramowitz
CHU Rennes, Gastroenterology, and Rennes University, France.
Marianne
M
Eléouet
Diaconnesses Hospital, Proctology, Paris, France.
Isabelle
I
Etienney
Institut Mutualiste Montsouris, Gastroenterology, Paris, France.
Philippe
P
Godeberge
Centre Tete d'Or, Physiotherapy, Lyon, France.
Guy
G
Valancogne
Hospices Civils de Lyon, Epidemiology Unit, Lyon, France.
Angélique
A
Denis
Hospices Civils de Lyon, Digestive Physiology, Lyon, France; University Lyon 1, France. Electronic address: francois.mion@chu-lyon.fr.
François
F
Mion
Hospices Civils de Lyon, Epidemiology Unit, Lyon, France; University Lyon 1, France.
Anne-Marie
AM
Schott
D000368:Aged; D000930:Antidiarrheals / Q000627:therapeutic use; D001676:Biofeedback, Psychology / Q000379:methods*; D003131:Combined Modality Therapy; D004035:Diet Therapy / Q000379:methods; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017060:Patient Satisfaction; D010502:Perineum / Q000503:physiopathology*; D026741:Physical Therapy Modalities; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000930:Antidiarrheals; D054368:Laxatives
Anal incontinence; Biofeedback; Quality of life; Randomized clinical trial