Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 3, CD002111

St Mark's Hospital, Physiology Unit, Northwick Park, Watford Road, Harrow, Middlesex, UK HA1 3UJ.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 3(3):CD002111. DOI: 10.1002/14651858.CD002111.pub2
Source: PubMed


Faecal incontinence (inability to control bowel movements or leaking stool) can be a very embarrassing and socially restricting problem. There are many possible causes, including childbirth damage to the muscles which control bowel movements. Exercises to strengthen these muscles and "biofeedback" (used to show people how to use the muscles properly) are often recommended. The review found that there is not enough evidence from trials to judge whether these treatments are helpful. Exercises and electrical stimulation used in the anus may be more helpful than vaginal exercises for women with faecal incontinence after childbirth. The 11 trials reviewed were of very limited value because they were generally small, of poor or uncertain quality, and compare different combinations of treatments.

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    • "Over 60 uncontrolled trials exist on the use of biofeedback for the management of FI [16]. Some authors conclude that biofeedback is the treatment of choice for FI on the basis of these observational studies [17]. "
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    ABSTRACT: Fecal incontinence (FI) is defined as the recurrent involuntary excretion of feces in inappropriate places or at inappropriate times. It is a major and highly embarrassing health care problem which affects about 2 to 24% of the adult population. The prevalence increases with age in both men and women. Physiotherapy interventions are often considered a first-line approach due to its safe and non-invasive nature when dietary and pharmaceutical treatment fails or in addition to this treatment regime. Two physiotherapy interventions, rectal balloon training (RBT) and pelvic floor muscle training (PFMT) are widely used in the management of FI. However, their effectiveness remains uncertain since well-designed trials on the effectiveness of RBT and PFMT versus PFMT alone in FI have never been published. A two-armed randomized controlled clinical trial will be conducted. One hundred and six patients are randomized to receive either PFMT combined with RBT or PFMT alone. Physicians in the University Hospital Maastricht include eligible participants. Inclusion criteria are (1) adults (aged > or = 18 years), (2) with fecal incontinence complaints due to different etiologies persisting for at least six months, (3) having a Vaizey incontinence score of at least 12, (4) and failure of conservative treatment (including dietary adaptations and pharmacological agents). Baseline measurements consist of the Vaizey incontinence score, medical history, physical examination, medication use, anorectal manometry, rectal capacity measurement, anorectal sensation, anal endosonography, defecography, symptom diary, Fecal Incontinence Quality of Life scale (FIQL) and the PREFAB-score. Follow-up measurements are scheduled at three, six and 12 months after inclusion. Skilled and registered physiotherapists experienced in women's health perform physiotherapy treatment. Twelve sessions are administered during three months according to a standardized protocol. This section discusses the decision to publish a trial protocol, the actions taken to minimize bias and confounding in the design, explains the choice for two treatment groups, discusses the secondary goals of this study and indicates the impact of this trial on clinical practice. The Netherlands Trial Register ISRCTN78640169.
    BMC Public Health 12/2007; 7(1):355. DOI:10.1186/1471-2458-7-355 · 2.26 Impact Factor
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    ABSTRACT: The current thesis describes the long-term results of rectal cancer treatment, specifically focusing on the etiology of functional morbidity. In a large prospective randomised trial long-term anorectal and urogenital dysfunction after rectal cancer treatment were evaluated. Poor functional outcome appears to occur commonly : about one third of patients reported urinary dysfunction, half of patients suffered from faecal incontinence and more than half of patients experienced deterioration of sexual functioning. Despite an additional effect of radiotherapy, it is concluded that pelvic organ dysfunction is mainly caused by surgical (nerve) damage. A combined anatomic and clinical study shows that the levator ani nerve, which has been neglected so far, might be involved. Furthermore, from a systematic review comparing central ligation techniques, it is concluded that neither the high tie nor the low tie strategy is evidence based and that low tie is anatomically less invasive with respect to circulation and autonomous innervation of the proximal limb of anastomosis. With respect to leukocyte depletion of red blood cell transfusion in patients with gastrointestinal cancer, a combined analysis of two randomised controlled trials shows no better long-term survival and lower cancer recurrence compared to simple buffy-coat removal.
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    ABSTRACT: Fecal incontinence is a symptom of many disorders that can affect the nerves and muscles controlling defecation; it is not just due to exceptionally voluminous diarrhea. Underlying problems should be identified and treated, because that may improve incontinence. If treatment of the underlying problem does not correct incontinence, several approaches can be employed successfully. General approaches include stimulation of defecation at intervals to empty the rectum under supervised conditions; treatment of diarrhea, if present; addressing coexisting psychologic problems, such as depression; use of continence aids, such as adult diapers; and perineal skin care to prevent skin breakdown. Drug therapy includes use of constipating drugs, such as loperamide or diphenoxylate, that can impede the gastrocolic reflex, thereby limiting rectal filling and the likelihood of incontinence. Biofeedback training is useful in patients with some ability to sense rectal distention and to contract the external anal sphincter; instrumental learning using manometric or electromyographic biofeedback can be used to reinforce the rectoanal contractile response to rectal distention. Improvement in continence has been noted in up to 70% of suitable candidates with a single biofeedback training session. Patients with external anal sphincter disruption due to childbirth injury or other trauma may benefit from direct external anal sphincter repair (sphincteroplasty). In others, tightening up the anal canal by encirclement with nonabsorbable mesh (Thiersch procedure), perianal injection of fat, collagen, or synthetic gel, or radiofrequency electrical energy (Stretta procedure) may provide some palliation. Creation of a new sphincter mechanism by muscle transposition and encirclement of the anal canal is another approach that has been improved by use of electrical stimulators to keep the neosphincter contracted. Artificial anal sphincters patterned after artificial urinary sphincters have met with some success, but local infection remains problematic. When all else fails, fecal diversion (ileostomy, colostomy) can be effective in rehabilitating patients.
    Current Treatment Options in Gastroenterology 09/2003; 6(4):319-327. DOI:10.1007/s11938-003-0024-7
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