Efficacy of anorectal biofeedback in scleroderma patients with fecal incontinence: a case-control study.
OBJECTIVE
To determine whether anorectal biofeedback therapy can improve the symptoms of fecal incontinence (FI) in patients with scleroderma when compared to patients with functional FI, and also whether there is any effect on anorectal physiology or quality of life (QOL). FI in patients with scleroderma is highly prevalent and is associated with significant loss of QOL. Biofeedback has been proven to be an effective treatment for functional FI, but there are no data to support its use in scleroderma.


METHODS
13 consecutive female patients (median age 59, IQR 47-65 years) with scleroderma, and 26 age- and parity-matched female patients with functional FI (disease controls, 2:1), underwent biofeedback therapy for management of FI. Fecal incontinence severity index (FISI), anorectal physiology, feeling of control and QOL were collected before and after 6 weeks of biofeedback therapy, with additional scoring repeated at 6-month follow-up.


RESULTS
After biofeedback treatment FISI, feeling of control and QOL significantly improved in both groups (p < 0.005). There was no difference in the degree in improvement in physiology, FISI or QOL between scleroderma patients and functional FI patients. Long-term improvement in FISI and control were seen in both groups and for QOL only in the scleroderma cohort (p < 0.05).


CONCLUSIONS
Patients with scleroderma benefit from biofeedback therapy to the same extent as that achieved in patients with functional FI. There are significant improvements in symptoms, physiology and QOL. Biofeedback is an effective, low-risk treatment option in this patient group.
a Department of Gastroenterology , Royal North Shore Hospital , St Leonards , NSW , Australia.
Josephine
J
Collins
a Department of Gastroenterology , Royal North Shore Hospital , St Leonards , NSW , Australia.
Yoav
Y
Mazor
b Department of Psychology , Macquarie University , North Ryde , NSW , Australia.
Michael
M
Jones
a Department of Gastroenterology , Royal North Shore Hospital , St Leonards , NSW , Australia.
John
J
Kellow
a Department of Gastroenterology , Royal North Shore Hospital , St Leonards , NSW , Australia.
Allison
A
Malcolm
D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D001315:Australia; D001676:Biofeedback, Psychology / Q000379:methods*; D016022:Case-Control Studies; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000150:complications*; D012720:Severity of Illness Index; D016896:Treatment Outcome
Anorectal manometry; biofeedback; fecal incontinence; quality of life; scleroderma