title: Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fecal incontinence in women - a randomized controlled trial.
abstract: OBJECTIVE
  Biofeedback and medical treatments have been extensively used for moderate fecal incontinence (FI). There is limited data comparing and combining these two treatments. The objective of this study was to evaluate the effect of biofeedback and medical treatments, separately and in combination.
  
  
  METHODS
  Sixty-four consecutive female patients, referred to a tertiary centre for FI, were included. The patients were randomized to start with either biofeedback (4-6 months) or medical treatment with loperamide and stool-bulking agents (2 months). Both groups continued with a combination of treatments, i.e. medical treatment was added to biofeedback and vice versa. A two-week prospective bowel symptom diary and anorectal physiology were evaluated at baseline, after single- and combination treatments.
  
  
  RESULTS
  Fifty-seven patients completed the study. Median number of leakage episodes during two weeks decreased from 6 to 3 (p < 0.0001) from baseline to completion. The patients showed a significant (1) decrease in number of leakages without forewarning (p = 0.04); (2) decrease in number of stools with urgency (p = 0.001); (3) decrease in number of loose stool consistency; and (4) an increase in rectal sensory thresholds, both for maximum tolerable rectal pressure and first sensation (<0.01). The combination treatment was superior to both single treatments in terms of symptoms and functions. There was no significant difference between the two groups at any time point.
  
  
  CONCLUSIONS
  The combination therapy with biofeedback and medical treatment is effective for symptom relief in FI. The symptom improvement was associated with improved fecal consistency, reduced urgency, and increased rectal sensory thresholds.
authors.affiliation: Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden.
authors.forename: Jenny
authors.initials: J
authors.lastname: Sjödahl
authors.forename: Susanna A
authors.initials: SA
authors.lastname: Walter
authors.forename: Elin
authors.initials: E
authors.lastname: Johansson
authors.forename: Anna
authors.initials: A
authors.lastname: Ingemansson
authors.forename: Ann-Katrine
authors.initials: AK
authors.lastname: Ryn
authors.forename: Olof
authors.initials: O
authors.lastname: Hallböök
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000502:physiology; D000930:Antidiarrheals / Q000008:administration & dosage*; D001676:Biofeedback, Psychology / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003672:Defecation; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008139:Loperamide / Q000008:administration & dosage*; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012677:Sensation; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000930:Antidiarrheals; D008139:Loperamide
keywords: anorectal manometry; biofeedback; incontinence; pelvic floor exercises