Abstract
Objective The main objective of this study is to evaluate the efficacy of pelvic floor muscle
exercise for the treatment of fecal incontinence after Soave procedure for Hirschsprung
disease (HD).
Methods A case series study was performed in 24 incontinent children after Soave pull-through
surgery for HD. Out of the 24 patients, 16 patients (training group) received pelvic
floor muscle training while the other 8 patients (control group) did not receive further
treatment. For children who received pelvic floor muscle training, biofeedback treatment
was given for 2 weeks in hospital and they were then instructed to carry out pelvic
floor muscle exercise at home. At the baseline and after 1 year of training, anorectal
manometry was performed to measure resting anal canal pressure, squeeze pressure,
and rectal sensation. Efficacy of pelvic floor muscle exercise for the treatment of
postoperative fecal incontinence was evaluated by the difference between baseline
and 1-year follow-up values. At the baseline, the characteristics of the incontinent
children were also compared with 18 children who were performed Soave operation for
HD and had normal anal function.
Results Lower resting anal canal pressure distinguished the incontinent children from the
continent ones. Resting pressure of the incontinent children was significantly improved
by pelvic floor muscle exercise: the baseline and 1-year follow-up values of the treatment
group were 18.6 ± 6.2 and 35.4 ± 8.7 mm Hg, respectively. Squeeze pressure and clinical
outcomes were also improved after the pelvic floor muscle training: only 3 out of
the 16 patients had occasional soiling after the training. No significant changes
in clinical outcome and manometry measurements were observed in the control group.
Conclusions The damage of internal anal sphincter might be one of the causes of fecal incontinence
after Soave procedure. The damage of internal anal sphincter could be caused by lower
level of dissection, vigorous anal dilation, and excessive anal canal traction during
operation. Pelvic floor muscle training is one procedure of choice to treat this complaint.
Keywords
Hirschsprung disease - Soave procedure - fecal incontinence - pelvic floor muscle
training
