Efficacy of Biofeedback Therapy before and after Sphincteroplasty for Fecal Incontinence because of Obstetric Injury: A Randomized Controlled Trial
Fecal incontinence is a challenging condition in that it exerts various psychosocial impacts on daily life. Different treatment modalities have been suggested for fecal incontinence. The present study aimed to evaluate the efficacy of biofeedback therapy in combination with surgery in the management of fecal incontinence.
The present randomized controlled trial was performed on 27 women with a complaint of fecal incontinence because of delivery trauma. The patients underwent sphincteroplasty and levatorplasty via the same method by 2 colorectal surgeons. In Group I, biofeedback therapy was performed 3 months before and 6 months after the surgery; in Group II, biofeedback therapy was applied only 6 months after the surgery; and in Group III, only surgical management was performed.
The results revealed a significant difference between the preoperative and postoperative Wexner scores of incontinence in all the 3 groups. Additionally, the difference between the preoperative and postoperative scores was significant only in Group I and Group III, but not in Group II. The reduction in the Wexner score was significantly less in Group III. However, no significant difference was observed between the 3 groups concerning the mean difference of preoperative and postoperative manometry.
The present study revealed no significant role for biofeedback therapy alone in the improvement of manometric evaluation. However, the Wexner score, which is an indicator of patient satisfaction, increased with biofeedback therapy following sphincteroplasty.
In general, surgical treatment is now reserved for selected patients with fecal incontinence and has recently been developed with biofeedback therapy.
Trial Registration Number: IRCT201206039936N1
Van Koughnett JA, Wexner SD. Current management of fecal incontinence: choosing amongst treatment options to optimize outcomes. World J Gastroenterol. 2013;19:9216-30. doi: 10.3748/wjg.v19.i48.9216. PubMed PMID: 24409050; PubMed Central PMCID: PMC3882396.
Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77-97. doi: 10.1007/BF02050307. PubMed PMID: 8416784.
Madoff RD. Surgical treatment options for fecal incontinence. Gastroenterology. 2004;126:S48-54. doi: 10.1053/j.gastro.2003.10.015. PubMed PMID: 14978638.
Baumgartner U. The artificial sphincter: therapy for faecal incontinence. Zentralbl Chir. 2012;137:340-4. doi: 10.1055/s-0032-1315109. PubMed PMID: 22933007.
Cheskin LJ, Schuster SM. Fecal incontinence. In: Hazzard WR, Andres R, Bierman EL, Blass JP, editors. Principles of geriatric medicine and gerontology. 2rd ed. New York: McGraw-Hill; 1990. p. 1143-5.
Mahony R, Behan M, O’Connell PR, O’Herlihy C. Effect of second vaginal delivery on anal function in patients at risk of occult anal sphincter injury after first forceps delivery. Dis Colon Rectum. 2008;51:1361-6. doi: 10.1007/s10350-008-9302-8. PubMed PMID: 18607553.
Mevik K, Norderval S, Kileng H, Johansen M, Vonen B. Long-term results after anterior sphincteroplasty for anal incontinence. Scand J Surg. 2009;98:234-8. PubMed PMID: 20218421.
Novi JM, Mulvihill BH, Morgan MA. Combined anal sphincteroplasty and perineal reconstruction for fecal incontinence in women. J Am Osteopath Assoc. 2009;109:234-6. PubMed PMID: 19369511.
Bharucha AE, Fletcher JG, Melton LJ, 3rd, Zinsmeister AR. Obstetric trauma, pelvic floor injury and fecal incontinence: a population-based case-control study. Am J Gastroenterol. 2012;107:902-11. doi: 10.1038/ajg.2012.45. PubMed PMID: 22415196; PubMed Central PMCID: PMC3509345.
Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN. Long-term results of anterior sphincteroplasty. Dis Colon Rectum. 2004;47:727-31; discussion 31-2. doi: 10.1007/s10350-003-0114-6. PubMed PMID: 15037931.
Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum. 2002;45:345-8. doi: 10.1007/s10350-004-6180-6. PubMed PMID: 12068192.
Wexner SD, Marchetti F, Jagelman DG. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum. 1991;34:22-30. doi: 10.1007/BF02050202 PubMed PMID: 1991416.
Byrne CM, Solomon MJ, Young JM, Rex J, Merlino CL. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum. 2007;50:417-27. doi: 10.1007/s10350-006-0846-1. PubMed PMID: 17476558.
Azizi R, Alvandipour M, Shoar S, Mahjoubi B. Combination of pseudocontinent perineal colostomy and appendicostomy: a new approach in the treatment of low rectal cancer. Surg Innov. 2013;20:471-7. doi: 10.1177/1553350612469280. PubMed PMID: 23228964.
Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum. 2009;52:1730-7. doi: 10.1007/DCR.0b013e3181b55455. PubMed PMID: 19966605; PubMed Central PMCID: PMC3855426.
Wang JY, Patterson TR, Hart SL, Varma MG. Fecal incontinence: does age matter? Characteristics of older vs. younger women presenting for treatment of fecal incontinence. Dis Colon Rectum. 2008;51:426-31. doi: 10.1007/s10350-007-9138-7. PubMed PMID: 18213493.
Bondurri A, Zbar AP, Tapia H, Boffi F, Pescatori M. The relationship between etiology, symptom severity and indications of surgery in cases of anal incontinence: a 25-year analysis of 1,046 patients at a tertiary coloproctology practice. Tech Coloproctol. 2011;15:159-64. doi: 10.1007/s10151-011-0682-8. PubMed PMID: 21538014.
Jensen LL, Lowry AC. Biofeedback improves functional outcome after sphincteroplasty. Dis Colon Rectum. 1997;40:197-200. doi: 10.1007/BF02054988. PubMed PMID: 9075757.
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. doi: 10.1056/NEJM197403212901202. PubMed PMID: 4813725.
Bartlett LM, Sloots K, Nowak M, Ho YH. Biofeedback therapy for faecal incontinence: a rural and regional perspective. Rural Remote Health. 2011;11:1630. PubMed PMID: 21375356.
View Counter: Abstract | 436 | and PDF | 0 |
- There are currently no refbacks.
pISSN: 0253-0716 eISSN: 1735-3688