IMPACT OF SATISFACTION RATE, SCORE, AND RISK FACTORS IN THE TREATMENT OF FECAL INCONTINENCE: BIOFEEDBACK, ELECTRO-STIMULATION, OR SACRAL NEUROMODULATION AS THE FIRST OPTION?

Introduction The treatment of fecal incontinence (FI) remains challenging, as patients expect effective and long-term results.

Objectives To evaluate the impact of satisfaction rate, score, and risk factors in patients with fecal incontinence treated with biofeedback (BIO), electrostimulation combined with biofeedback (ELET + BIO), or sacral neuromodulation (NS) as the first option.

Methodology Prospective data from women treated for FI over a 5-year period, without surgical indication and capable of undergoing BIO treatment. The fecal incontinence score (Cleveland Clinic Fecal Incontinence Score – CCFIS), 3D anorectal ultrasonography, and anal manometry were assessed. The patients were matched by age and grouped into: BIO, ELET + BIO, and NS. Within each group, they were subdivided by CCFIS ≤ 10 vs. CCFIS > 10. Risk factors, scores, percentage of response, and satisfaction rates (using a visual analog scale – EVA [0 = best; 100 = worst]) were compared before and after treatment. The follow-up period was 6 months for BIO and ELET + BIO and at least one year for NS. ANOVA and paired tests were used.

Results A total of 165 women were included: 58 treated with BIO (CCFIS ≤ 10 = 34, CCFIS > 10 = 24); 51 treated with ELET + BIO (31, 20); and 56 treated with NS (11, 45). The number of vaginal deliveries, sphincter defects, and previous surgeries were similar across groups. Resting pressure was lower in the NS group. The pre-treatment satisfaction impact (EVA) was higher in the NS group (p < 0.00). There was significant improvement in the score and EVA compared to pre- and post-treatment in all three groups. However, the percentage of improvement was higher in the NS group compared to BIO and ELET + BIO (88% vs. 43% vs. 34%, p < 0.00), and the satisfaction scale showed the best post-treatment response in the NS group (16 vs. 49 vs. 57, p = 0.00). Additionally, all patients in the NS group showed a symptom improvement rate of FI > 50%, with 30% achieving complete continence. Subgroup analysis showed that the improvement percentage and satisfaction were higher after NS in both subgroups (CCFIS ≤ 10: NS = 94% vs. BIO = 48% vs. ELET + BIO = 40%, p < 0.00) and (CCFIS > 10: NS = 87% vs. BIO = 36% vs. ELET + BIO = 24%, p < 0.00), as well as better satisfaction (CCFIS ≤ 10: NS = 9 vs. BIO = 39 vs. ELET + BIO = 47, p = 0.00) and (CCFIS > 10: NS = 18 vs. BIO = 64 vs. ELET + BIO = 73, p < 0.00).

Conclusion All three modalities led to reduced scores, and no risk factors were identified that influenced the results. However, the improvement percentage and satisfaction rate had an impact on the choice of sacral neuromodulation as the first treatment option, even in patients with CCFIS ≤ 10.