Abstract
PURPOSE: Our aim was to prospectively evaluate pelvic floor retraining (PFR) in improving symptomatic fecal incontinence. METHODS: PFR was used to treat 30 patients with fecal incontinence (28 women; age range, 29–85 (median, 68) years). PFR was performed by a physiotherapist in the outpatient department according to a strict protocol and included biofeedback using an anal plug electromyometer. Manometry (24 patients), pudendal nerve terminal motor latency (PNTML, 16 patients), and anal ultrasound (14 patients) were done before commencing therapy. Independent assessment of symptoms was done at the commencement of therapy, at 6 weeks, and at 6 and 12 months posttherapy. RESULTS: Twenty patients (67 percent) had improved incontinence scores, with eight patients (27 percent) being completely or nearly free of symptoms. Of 28 patients followed up longer than six months, 14 achieved a 25 percent or greater improvement at six weeks, which was sustained in all cases. Fourteen had an initial improvement of less than 25 percent, with only four (29 percent) showing later improvement (P<0.0001). There was no relationship between results of the therapy and patient age, initial severity of symptoms, etiology of incontinence, and results of anal manometry, PNTML, and anal ultrasound. CONCLUSIONS: PFR is a physical therapy that should be considered as the initial treatment in patients with fecal incontinence. An improvement can be expected in up to 67 percent of patients. Initial good results can predict overall outcome.
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References
Duthie HL, Watts J. Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 1965;6:64–8.
Bartolo DC, Roe AM, Locke-Edmunds JC, Virjee J, Mortensen NJ. Flap valve theory of anorectal incontinence. Br J Surg 1986;73:1012–4.
Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg 1991;78:312–4.
Deen KI, Kumar D, Williams JG, Olliff J, Keighley MR. The prevalence of anal sphincter defects in faecal incontinence: a prospective endosonic study. Gut 1993;34:685–8.
Snooks SJ, Swash M, Henry MM, Setchell M. Effect of vaginal delivery on the pelvic floor: a five-year follow-up. Br J Surg 1990;77:1358–60.
Lubowski DZ, Swash M, Nicholls RJ, Henry MM. Increase in pudendal nerve terminal motor latency with defaecation straining. Br J Surg 1988;75:1095–7.
Jorge JMN, Wexner SD, Ehrenpreis ED, Nogueras JJ, Jagelman DG. Does perineal descent correlate with pudendal neuropathy? Dis Colon Rectum 1993;36:475–83.
Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. N Engl J Med 1974;290:646–9.
Goldenberg DA, Hodges K, Hersh T, Jinich H. Biofeedback for fecal incontinence. Am J Gastroenterol 1980;74:342–5.
Cerulli MA, Nikoomanesh P, Schuster MM. Progress in biofeedback for fecal incontinence. Gastroenterology 1979;76:742–6.
Wald A. Biofeedback for fecal incontinence. Ann Intern Med 1981;95:146–9.
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.
Buser WD, Miner PB. Delayed rectal sensation with fecal incontinence: successful treatment using anorectal manometry. Gastroenterology 1986;91:1186–91.
MacLeod J. Management of anal incontinence by biofeedback. Gastroenterology 1987;93:291–294.
Loening-Baucke V. Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function. Gut 1990;31:1395–402.
Miner PB, Donnelly TC, Read NW. Investigation of mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 1990;35:1291–8.
Keck JO, Staniunas RJ, Coller JA,et al. Biofeedback training is useful fecal incontinence but disappointing in constipation. Dis Colon Rectum 1994;37:1271–6.
Enck P, Däublin G, Lübke HJ, Strohmeyer G. Long-term efficacy of biofeedback training for fecal incontinence. Dis Colon Rectum 1994;37:997–1001.
Jensen LL, Lowry AC. Biofeedback: a viable treatment option for anal incontinence [meeting abstract]. Dis Colon Rectum 1991;34:P6.
Enck P. Biofeedback training in disordered defecation: a critical review. Dig Dis Sci 1993;38:1953–60.
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.
Sousa A Jr, Araújo SA, Damico FM, Cordeiro AC, Pinotti HW, Gama AH. Manometric findings prior to and after biofeedback for anal incontinence [meeting abstract]. Dis Colon Rectum 1994;37:P24.
Chiarioni G, Scattolini C, Bonfante F, Vantini I. Liquid stool incontinence with severe urgency: anorectal function and effective biofeedback treatment. Gut 1993;34:1576–80.
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Read at the Tripartite Colorectal Meeting, London, United Kingdom, July 8 to 10, 1996.
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Rieger, N.A., Wattchow, D.A., Sarre, R.G. et al. Prospective trial of pelvic floor retraining in patients with fecal incontinence. Dis Colon Rectum 40, 821–826 (1997). https://doi.org/10.1007/BF02055440
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DOI: https://doi.org/10.1007/BF02055440