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Electrical Stimulation and Pelvic Floor Muscle Training With Biofeedback in Patients With Fecal Incontinence: A Cohort Study of 281 Patients

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Diseases of the Colon & Rectum

Purpose

Pelvic floor rehabilitation is an appealing treatment for patients with fecal incontinence but reported results vary. This study was designed to assess the outcome of pelvic floor rehabilitation in a large series of consecutive patients with fecal incontinence caused by different etiologies.

Methods

A total of 281 patients (252 females) were included. Data about medical history, anal manometry, rectal capacity measurement, and endoanal sonography were collected. Subgroups of patients were defined by anal sphincter complex integrity, and nature and possible underlying causes of fecal incontinence. Subsequently patients were referred for pelvic floor rehabilitation, comprising nine sessions of electric stimulation and pelvic floor muscle training with biofeedback. Pelvic floor rehabilitation outcome was documented with Vaizey score, anal manometry, and rectal capacity measurement findings.

Results

Vaizey score improved from baseline in 143 of 239 patients (60 percent), remained unchanged in 56 patients (23 percent), and deteriorated in 40 patients (17 percent). Mean Vaizey score reduced with 3.2 points (P < 0.001). A Vaizey score reduction of ≥ 50 percent was observed in 32 patients (13 percent). Mean squeeze pressure (+5.1 mmHg; P = 0.04) and maximal tolerated volume (+11 ml; P = 0.01) improved from baseline. Resting pressure (P = 0.22), sensory threshold (P = 0.52), and urge sensation (P = 0.06) remained unchanged. Subgroup analyses did not show substantial differences in effects of pelvic floor rehabilitation between subgroups.

Conclusions

Pelvic floor rehabilitation leads overall to a modest improvement in severity of fecal incontinence, squeeze pressure, and maximal tolerated volume. Only in a few patients, a substantial improvement of the baseline Vaizey score was observed. Further studies are needed to identify patients who most likely will benefit from pelvic floor rehabilitation.

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Acknowledgments

The authors thank the following participating investigators of our study group for scientific advice and collecting data: J. B. V. M. Delemarre, M.D., Ph.D.a; E. van der Harst, M.D., Ph.D.; P. P. L. O. Coene, M.D., Ph.D.; E. J. Spillenaar-Bilgen, M.D., Ph.D.; V. H. van der Vaart, M.D., Ph.D.; W. F. van Tets, M.D., Ph.D.; J. J. G. M. Gerritsen, M.D., Ph.D.; J. W. de Bruijne, M.D.; M. G. W. Dijkgraaf, Ph.D.; R. G. H. Beets-Tan, M.D., Ph.D.; V. P. M. van der Hulst, M.D., Ph.D.; T. G. Wiersma, M.D., Ph.D.; M. N. J. M. Wasser, M.D., Ph.D.; A. B. Huisman, M.D., Ph.D.; J. A. de Priester, M.D., Ph.D.; A. C. Sikkenk, M.D.; T. D. Witkamp, M.D. aDeceased.

Author information

Authors and Affiliations

  1. Department of Radiology, Academic Medical Center, G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    M. P. Terra M.D., Ph.D., A. C. Dobben M.Sc. & J. Stoker M.D., Ph.D.

  2. Department of Urology, University Hospital Maastricht, Maastricht, The Netherlands

    B. Berghmans Ph.D.

  3. Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands

    M. Deutekom Ph.D. & P. M. M. Bossuyt Ph.D.

  4. Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands

    C. G. M. I. Baeten M.D., Ph.D.

  5. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    L. W. M. Janssen M.D., Ph.D.

  6. Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

    G. E. E. Boeckxstaens M.D., Ph.D.

  7. Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands

    A. F. Engel M.D., Ph.D.

  8. Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands

    R. J. F. Felt-Bersma M.D., Ph.D.

  9. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

    J. F. M. Slors M.D., Ph.D.

  10. Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    M. F. Gerhards M.D., Ph.D.

  11. Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands

    A. B. Bijnen M.D., Ph.D.

  12. Department of Gynecology, Medical Spectrum Twente, Enschede, The Netherlands

    E. Everhardt M.D., Ph.D.

  13. Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands

    W. R. Schouten M.D., Ph.D.

Authors
  1. M. P. Terra M.D., Ph.D.
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  2. A. C. Dobben M.Sc.
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  3. B. Berghmans Ph.D.
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  4. M. Deutekom Ph.D.
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  5. C. G. M. I. Baeten M.D., Ph.D.
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  6. L. W. M. Janssen M.D., Ph.D.
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  7. G. E. E. Boeckxstaens M.D., Ph.D.
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  8. A. F. Engel M.D., Ph.D.
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  9. R. J. F. Felt-Bersma M.D., Ph.D.
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  10. J. F. M. Slors M.D., Ph.D.
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  11. M. F. Gerhards M.D., Ph.D.
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  12. A. B. Bijnen M.D., Ph.D.
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  13. E. Everhardt M.D., Ph.D.
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  14. W. R. Schouten M.D., Ph.D.
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  15. P. M. M. Bossuyt Ph.D.
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  16. J. Stoker M.D., Ph.D.
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Corresponding author

Correspondence to M. P. Terra M.D., Ph.D..

Additional information

Supported by grant 945-01-013 of the Netherlands Organization for Health Research and Development.

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Terra, M.P., Dobben, A.C., Berghmans, B. et al. 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 (2006). https://doi.org/10.1007/s10350-006-0569-3

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