Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 3, CD002111
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.
Available from: Bary Berghmans
- "Over 60 uncontrolled trials exist on the use of biofeedback for the management of FI . Some authors conclude that biofeedback is the treatment of choice for FI on the basis of these observational studies . "
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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.
Available from: leidenuniv.nl
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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: The aim of this study was to assess the long-term clinical and quality of life outcomes for patients after referral to a four-month treatment program for fecal incontinence based on pelvic floor exercises and biofeedback. Secondary objectives were to document patients' subsequent treatment activities and their perception of the biofeedback training; to establish the long-term outcomes and initial predictors for the subset of patients who did not complete the treatment, or who failed to improve during the program; and to correlate changes in clinical outcome measures and quality of life over time.
Patients were contacted by telephone to determine their perception of progress subsequent to the treatment program, any subsequent treatment or activities relating to their fecal incontinence, and which aspect of the treatment program they believed was most helpful. St. Mark's and Pescatori fecal incontinence scores were also recorded, along with patients' self-assessments of their incontinence severity and quality of life.
Eighty-three (69 percent) patients were contacted for interviews at a median of 42 (range, 26-56) months after program completion. At the time of follow-up, patients who completed the program continued to enjoy strongly significant improvements in all outcome measures, with 75 percent perceiving a symptomatic improvement and 83 percent reporting improved quality of life. For many patients, improvement continued subsequent to program completion. Patients whose incontinence scores became worse during treatment still reported improvement in their quality of life and perceived incontinence severity during the same time period; many experienced some degree of "catch-up" in their continence scores during the follow-up period. Fourteen patients (17 percent) went on to have surgery for fecal incontinence; of these, 6 (7 percent) had a stoma. Twenty (24 percent) regularly took antidiarrheal medication. Thirty program completers (41 percent) were continuing pelvic floor exercises.
This study confirms the long-term improvement in fecal incontinence achieved through treatment with biofeedback and pelvic floor exercises. In this study, patients also continued to improve after treatment completion, possibly because of the strong emphasis placed on patients during treatment to continue the pelvic floor exercises on their own. The poor correlation between quality of life and quantitative scores of fecal incontinence suggests that there are important aspects of continence that are not being appropriately recognized.
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