Treatment options for fecal incontinenceBehavioral management of fecal incontinence in adults
Section snippets
Elements of biofeedback
Many different treatments have been used in the name of biofeedback. The clinicians who originally devised biofeedback training for fecal incontinence described it as an operant conditioning therapy.1 The aim was for the patient to learn to enhance the presumed reflex contraction of the external anal sphincter (EAS) muscle in response to a reflex relaxation of the internal anal sphincter muscle, which was induced by stimulating the rectoanal inhibitory reflex by using distention with a rectal
Lack of standardization in studies
Three randomized, controlled trials have attempted to evaluate the different components of biofeedback.10, 14, 15 Unfortunately, 2 of those trials had very complex designs that, on the basis of the data presented, make analysis of the different components impossible.10, 15 In one trial, decreasing the threshold for sensing rectal distention did seem to help reduce symptoms.10 Heymen et al.16 compared 4 methods of biofeedback (EMG; EMG plus rectal balloon; EMG plus home biofeedback; and EMG,
Variety of outcome measures
In a systematic review of studies involving anal sphincter biofeedback and pelvic floor exercises for fecal incontinence, we noted a wide variety of outcome measures.20 Most studies considered in this review chose reduction of episodes of fecal incontinence as the primary end point; however, few studies explicitly stated that diaries or questionnaires were used to gather this information. The criteria for success in these studies varied from a 90% reduction21, 22 to a 50% reduction23 in
Cochrane systematic review of controlled clinical trials
A separate Cochrane review of controlled studies of biofeedback and exercises for fecal incontinence has been conducted.38 Cochrane reviews include only evidence from randomized or quasi-randomized controlled trials that are considered to have the highest-quality evidence for efficacy of healthcare interventions. The Cochrane review of controlled studies of biofeedback and exercises for fecal incontinence concluded that “there is not enough evidence from trials to judge whether these treatments
Report of a randomized, controlled trial of biofeedback in adults
Our aim was to conduct a randomized, controlled trial to determine whether exercises or biofeedback produced any change in patients’ fecal incontinence symptoms.
Future research needs
There is a need for better-designed randomized, controlled trials with adequate numbers of patients to evaluate different exercise programs and different elements of biofeedback. Control groups are essential for distinguishing between true therapeutic effects of treatment and the inevitably large effect of intervening per se in any functional problem with behavioral methods. Clinical series have indicated that biofeedback, as it is practiced in most clinics, has a positive effect on fecal
Summary
Behavioral management, or biofeedback, has been advocated as the management technique of first choice for symptoms of mild to moderate fecal incontinence.46 A recent systematic review found that in clinical series, up to one half of patients with fecal incontinence were rendered symptom free and up to two thirds had decreased symptoms after biofeedback.20 However, evidence from studies using rigorous scientific methods is scant.38 Results of a recent study by this author suggest that the
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