Abstract
Background
The current literature does not provide unequivocal data on prognostic factors in conservative management of fecal incontinence. Moreover, the physiopathologic effects of pelvic floor rehabilitation on anorectal function are not well understood. Our aim is to identify some prognostic parameters and assess their effects on anorectal physiology of biofeedback therapy plus anal electrostimulation for fecal incontinence.
Methods
We studied prospectively 45 consecutive adult patients with fecal incontinence treated at our institution with biofeedback plus electrostimulation. The outcome parameter was modification of the Wexner Incontinence Score (WIS) at the end of treatment. In addition, we studied the modifications of anorectal manometry and the rectal sensitivity threshold after treatment.
Results
At univariate analysis, age, the pretreatment WIS, and the pretreatment resting and maximum squeeze pressures were correlated with the clinical outcome. Patients showed a significant reduction in the rectal sensitivity threshold but no significant change in manometric parameters after treatment.
Conclusions
We identify good sphincter function and mild to moderate symptomatology as favorable prognostic factors in biofeedback and anal electrostimulation therapy. Improvement in rectal sensitivity can be implicated in symptomatic improvement. The impossibility of correlating the clinical results with the effects on anorectal physiology suggests a nonspecific effect of conservative treatment.
Similar content being viewed by others
References
Chatoor DR, Taylor SJ, Cohen CRG et al (2007) Faecal incontinence. Br J Surg 94:134–144
Heymen S, Jones KR, Ringel Y et al (2001) Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum 44:728–736
Sangwan YP, Coller JA, Barrett RC et al (1995) Can manometric parameters predict response to biofeedback therapy in fecal incontinence? Dis Colon Rectum 38:1021–1025
Ko CY, Tong J, Lehman RE et al (1997) Biofeedback is effective therapy for fecal incontinence and constipation. Arch Surg 132:829–833
Ho YH, Chiang J, Tan M et al (1996) Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy. Dis Colon Rectum 39:1289–1292
Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Rieger NA, Wattchow DA, Sarre RG et al (1997) Prospective trial of pelvic floor retraining in patients with fecal incontinence. Dis Colon Rectum 40:821–826
Glia A, Gylin M, Åkerlund JE et al (1998) Biofeedback training in patients with fecal incontinence. Dis Colon Rectum 41:359–364
Norton C, Chelvanayagam S, Wilson-Barnett J et al (2003) Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 125:1320–1329
Chiarioni G, Scattolini C, Bonfante F et al (1993) Liquid stool incontinence with severe urgency: anorectal function and effective biofeedback treatment. Gut 34:1576–1580
Keck JO, Staniunas RJ, Coller JA et al (1994) Biofeedback training is useful in fecal incontinence but disappointing in constipation. Dis Colon Rectum 37:1271–1276
Van Tets WF, Kuijpers JHC, Bleijenberg G (1996) Biofeedback treatment is ineffective in neurogenic fecal incontinence. Dis Colon Rectum 39:992–994
Fynes MM, Marshall K, Cassidy M et al (1999) A prospective, randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma. Dis Colon Rectum 42:753–761
Leroi AM, Dorival MP, Frangoise M et al (1999) 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
Norton C, Kamm MA (1999) Outcome of biofeedback for faecal incontinence. Br J Surg 86:1159–1163
Chiarioni G, Bassotti G, Stegagnini S et al (2002) Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. Am J Gastroenterol 97:109–117
Ryn AK, Morren GL, Hallböök O et al (2000) Long-term results of electromyographic biofeedback training for fecal incontinence. Dis Colon Rectum 43:1262–1266
Solmon MJ, Pager CK, Roberts R et al (2003) Randomized controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence. Dis Colon Rectum 46:703–710
Fernandez-Fraga X, Azpiroz F, Aparici A et al (2003) Predictors of response to biofeedback treatment in anal incontinence. Dis Colon Rectum 46:1218–1225
Terra MP, Dobben AC, Berghmans MB et al (2006) Electrical stimulation and pelvic floor muscle training with biofeedback in patients with fecal incontinence: a cohort study of 281 patients. Dis Colon Rectum 49:1149–1159
Byrne CM, Solomon MJ, Young JM et al (2007) Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum 50:417–427
Norton C, Kamm MA (2001) Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults: a systematic review. Aliment Pharmacol Ther 15:1147–1154
Tan JJY, Chan M, Tjandra JJ (2007) Evolving therapy for fecal incontinence. Dis Colon Rectum 50:1950–1967
Whitehead WE, Corazziari E, Prizont R et al (1999) Definition of a responder in clinical trials for functional gastrointestinal disorders: report on a symposium. Gut 45 (Suppl 2):ii78–ii79
Goldenberg DA, Hodges K, Hershe T et al (1980) Biofeedback therapy for fecal incontinence. Am J Gastroenterol 74:342–345
Rao SS, Welcher KD, Happel J (1996) Can biofeedback therapy improve anorectal function in fecal incontinence? Am J Gastroenterol 91:2360–2366
Loening-Baucke V (1990) Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function. Gut 31:1395–1402
Norton C, Gibbs A, Kamm MA (2005) Randomized, controlled trial of anal electrical stimulation for fecal incontinence. Dis Colon Rectum 49:190–196
Wald A, Tunuguntla AK (1984) Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus: modification with biofeedback therapy. N Engl J Med 310:1282–1287
Buser WD, Miner PB (1986) Delayed rectal sensation with faecal incontinence: successful treatment using anorectal manometry. Gastroenterology 91:1186–1191
Miner PB, Donnelly TC, Read NW (1990) Investigation in the mode of action of biofeedback in the treatment of faecal incontinence. Dig Dis Sci 35:1291–1298
Heymen S, Pikarsky A, Weiss E et al (2000) A prospective randomized trial comparing four biofeedback techniques for patients with fecal incontinence. Colorectal Dis 2:88–92
Deutekom M, Terra MP, Dobben AC et al (2005) Selecting an outcome measure for evaluating treatment in fecal incontinence. Dis Colon Rectum 48:2294–2301
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Boselli, A.S., Pinna, F., Cecchini, S. et al. Biofeedback Therapy Plus Anal Electrostimulation for Fecal Incontinence: Prognostic Factors and Effects on Anorectal Physiology. World J Surg 34, 815–821 (2010). https://doi.org/10.1007/s00268-010-0392-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-010-0392-9