title: Improvement of fecal incontinence and quality of life by electrical stimulation and biofeedback for patients with low rectal cancer after intersphincteric resection.
abstract: OBJECTIVE
  To assess the efficacy and benefits of pelvic rehabilitation programs in terms of functional outcomes and quality of life for patients with fecal incontinence and defecation disorders after rectal cancer surgery.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  University hospital physiotherapy clinics.
  
  
  METHODS
  Patients (N=32) who experienced fecal incontinence after sphincter-saving surgery with the intersphincteric resection (ISR) technique and could follow and cooperate with the treatment schedule were included in the present study.
  
  
  METHODS
  Pelvic rehabilitation programs included electrical stimulation (ES) and biofeedback (BF).
  
  
  METHODS
  Functional results, Wexner score, and anorectal manometry were used to assess the clinical outcomes of rehabilitation treatment.
  
  
  RESULTS
  Maximum squeeze pressure improved after rehabilitation training (P=.014). There were no statistical differences in resting pressure, resting muscle electromyography, and maximum squeeze electromyography (P=.061, P=.76, and P=.99, respectively). The mean stool frequency was 18.8 per 24 hours before the pelvic intervention program and 7.8 per 24 hours after ES and BF training (P<.001). Of the 32 patients, 27 required antidiarrheal medications before treatment, and after completion of the training, only 9 patients still needed antidiarrheal medications (P<.001). Significant improvements were observed in the Wexner score (17.74 vs 12.93; P<.001).
  
  
  CONCLUSIONS
  Our data show that ES and BF are effective in the treatment of fecal incontinence, leading to improvement of quality of life for patients with low rectal cancer after ISR.
authors.affiliation: Division of General Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: kuolijen@gmail.com.
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Kuo
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Lai
authors.affiliation: Biostatistics and Research Consultation Center, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yen-Kuang
authors.initials: YK
authors.lastname: Lin
authors.affiliation: Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Yu-Shih
authors.initials: YS
authors.lastname: Huang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Chia-Chen
authors.initials: CC
authors.lastname: Hu
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: CSC@tmu.edu.tw.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography; D005242:Fecal Incontinence / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*
keywords: Electric stimulation; Fecal incontinence; Rectal neoplasms; Rehabilitation