Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence


PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29–74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeedback sessions. RESULTS: Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy. CONCLUSION: In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.

This is a preview of subscription content, access via your institution.


  1. 1.

    Enck P. Biofeedback training in disordered defecation: a critical review. Dig Dis Sci 1993;11:1953–60.

    Google Scholar 

  2. 2.

    Guillemot F, Bouche B, Gower-Rousseau C,et al. Biofeedback for the treatment of fecal incontinence: long-term clinical results. Dis Colon rectum 1995;38:393–7.

    PubMed  Google Scholar 

  3. 3.

    Motson RW. Sphincter injuries: indications for, and results of sphincter repair. Br J Surg 1985;72(Suppl):S19–21.

    PubMed  Google Scholar 

  4. 4.

    Laurberg S, Swash M, Henry MM. Delayed external sphincter repair for obstetric tear. Br J Surg 1988;75:786–8.

    PubMed  Google Scholar 

  5. 5.

    Simmang C, Birnbaum EH, Kodner IJ, Fry RD, Fleshman JW. Anal sphincter reconstruction in the elderly: does advancing age affect outcome? Dis Colon Rectum 1994;37:1065–9.

    Google Scholar 

  6. 6.

    Sangwan YP, Coller JA, Barrett RC,et al. Unilateral pudendal neuropathy: impact on outcome of anal sphincter repair. Dis Colon Rectum 1996;39:686–9.

    Google Scholar 

  7. 7.

    Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) fecal incontinence. Br J Surg 1984;71:614–6.

    PubMed  Google Scholar 

  8. 8.

    Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal sphincter disruption during vaginal delivery. N Engl J Med 1993;329:1905–11.

    Article  PubMed  Google Scholar 

  9. 9.

    Rieger NA, Wattchow DA, Sarre RG,et al. Prospective trial of pelvic floor retraining in patients with fecal incontinence. Dis Colon Rectum 1997;40:821–6.

    Google Scholar 

  10. 10.

    van Tets WF, Kuijpers JH, Bleijenberg G. Biofeedback treatment is ineffective in neurogenic fecal incontinence. Dis Colon Rectum 1996;39:992–4.

    Article  PubMed  Google Scholar 

  11. 11.

    Loening-Baucke V. Efficacy of biofeedback training in improving fecal incontinence and anorectal physiologic function. Gut 1990;31:1395–402.

    PubMed  Google Scholar 

  12. 12.

    Miner PB, Donelly TC, Read NW. Investigation of the mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 1990;35:1291–8.

    Article  PubMed  Google Scholar 

  13. 13.

    Martelli H, Devroede G, Arhan P, Duguay C, Dornic C, Faverdin C. Some parameters of large bowel motility in normal man. Gastroenterology 1978;75:612–8.

    PubMed  Google Scholar 

  14. 14.

    Devroede G, Hemond M. Anorectal manometry: a small balloon tube. In: Smith LE, ed. Practical guide to anorectal testing. New-York, Tokyo: Igaku Shoin, 1990:55–64.

    Google Scholar 

  15. 15.

    Sangwan YP, Coller JA, Barrett RC, Murray JJ, Roberts PL, Schoetz DJ Jr. Unilateral pudendal neuropathy: significance and implications. Dis Colon Rectum 1996;39:249–51.

    Google Scholar 

  16. 16.

    Sangwan YP, Coller JA, Barrett RC, Roberts PL, Murray JJ, Schoetz DJ Jr. Can manometric parameters predict response to biofeedback therapy in fecal incontinence? Dis Colon Rectum 1995;38:1021–5.

    Article  PubMed  Google Scholar 

  17. 17.

    Latimer PR, Campbell D, Kasperski J. A component analysis of biofeedback in the treatment of fecal incontinence. Biofeedback Self Regul 1984;9:311–24.

    Article  PubMed  Google Scholar 

  18. 18.

    Wald A. Biofeedback for neurogenic fecal incontinence: rectal sensation is a determinant of outcome. J Pediatr Gastroenterol Nutr 1983;2:302–6.

    PubMed  Google Scholar 

  19. 19.

    Denis P, Dewe C, Dorival M P,et al. Expérience des problèmes soulevés par le biofeedback au sein d'une équipe hospitalière. Gastroenterol Clin Biol 1990;14:5–7.

    PubMed  Google Scholar 

  20. 20.

    Roig JV, Villoslada C, Lledó S,et al. Prevalence of pudendal neuropathy in fecal incontinence: results of a prospective study. Dis Colon Rectum 1995;38:952–8.

    Article  PubMed  Google Scholar 

  21. 21.

    Cerulli MA, Nikoomanesh P, Schuster MM. Progress in biofeedback conditioning for fecal incontinence. Gastroenterology 1979;76:742–6.

    PubMed  Google Scholar 

  22. 22.

    MacLeod JH. Management of anal incontinence by biofeedback. Gastroenterology 1987;93:291–4.

    PubMed  Google Scholar 

  23. 23.

    Buser WD, Miner PB Jr. Delayed rectal sensation with fecal incontinence: successful treatment using anorectal manometry. Gastroenterology 1986;91:1186–91.

    PubMed  Google Scholar 

  24. 24.

    Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus: modification with biofeedback therapy. N Engl J Med 1984;310:1282–7.

    PubMed  Google Scholar 

  25. 25.

    Jensen LL, Lowry AC. Biofeedback improves functional outcome after sphincteroplasty. Dis Colon Rectum 1997;40:197–200.

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Dr. Anne-Marie Leroi M.D..

About this article

Cite this article

Leroi, AM., Dorival, MP., Lecouturier, MF. et al. Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum 42, 762–769 (1999). https://doi.org/10.1007/BF02236932

Download citation

Key words

  • Biofeedback
  • Incontinence
  • Pudendal neuropathy
  • Anal endosonography