Fecal incontinence is a common health care problem affecting 1–7% of the population.
The aim of this study was to determine the efficacy of biofeedback therapy in patients with
passive anal incontinence.
Patients and methods: 8 patients (1 male, 7 females, median age: 54yrs, range: 21–72yrs) were recruited
into the biofeedback program. Colonoscopy and defecography were performed to close
out structural and functional abnormality of the rectosigmoideal region. Structural
sphincter damage and perineal body disruption were closed out by anal utrasonography.
Patients with perception abnormality were not eligible for the study. The severity
of incontinence was determined by the Cleveland score system. Vector volume, sphincter
length, basal pressure, squeeze, endurance squeeze, fatigue slope was determined before
and after biofeedback therapy. Biofeedback was performed using by a four channel,
water perfused manometry system, each session lasted for 20min. Biofeedback was continued
while patients subjective symptoms decreased to „improved“ or „cured“ level. Median
time was 13.5 weeks for symptom relief.
Results: Average length of the anal sphincter was 2.6±1cm. Biofeedback led to a significant
increase of the continence score (15.25±2.3 vs. 5.25±4 p<0.05). Both squeezing (64.8±14.2
vs. 71.9±11mmHg, NS) and resting pressure (28.32±6.8 vs. 33.2±4.9mmHg, NS) as well
as endurance squeezing pressure (29.8±4.5 vs. 33.5±5.3mmHg, NS) prone to increase,
but no statistical significance could be obtained during the training period. The
maximal tolerable volume were increased (168.7±20.4 vs. 333.7±30.6ml, p<0.05) and
fatigue slope was decreased (0.37±0.07 vs. 0.18±0.02mmHg/s, p<0.05) significantly.
Conclusion: The improvement of ability to sustain a squeeze for 30 seconds, a decreased fatigue
rate and an increased compliance of the rectum might be involved in the beneficial
effect of biofeedback therapy in the control of anorectal function.
This study was supported by the grant ETT 550/2003.
