CAN BIOFEEDBACK THERAPY IMPROVE ANORECTAL FUNCTION IN FECAL INCONTINENCE

Background: Although biofeedback treatment ameliorates symptoms in pat ients with fecal incontinence. whether it improves anorectal function is unclear. Aim: To examine prospectively whether biofeedback therapy influences objective and subjective parameters of anorectal function a nd whether it improves outcome, Methods: Nineteen consecutive patients (females = 17) with fecal incontinence for over 1 year, underwent a t hree-phase outpatient treatment program. This program consisted of pel vic muscle strengthening exercises (phase 1), l-h biofeedback therapy sessions twice a week (phase 2), and reinforcement sessions at 6 wk, 3 , 6, and 12 months (phase 3). The number of sessions in phase 2 were c ustomized for each patient. Anorectal manometry, saline continence tes t, prospective stool diaries, and bowel satisfaction scores were used to assess the changes in bowel function before and 1 year after therap y. Results: After biofeedback therapy, the anal squeeze sphincter pres sure (p < 0.05), the duration of squeeze (p < 0.001), and the capacity to retain liquids (p < 0.05) increased. Rectoanal coordination also i mproved with a reduction (p < 0.001) in rectal pressure and an increas e (p < 0.05) in the continence index. Threshold volumes for first perc eption and desire to defecate decreased (p < 0.05). The number of ther apy sessions varied, mean (range) = 7 (4-13). Stool frequency and the number of incontinence episodes decreased (p < 0.001). Bowel satisfact ion score improved (p < 0.001). Conclusions: Biofeedback therapy is ef fective and improves objective and subjective parameters of anorectal function in patients with fecal incontinence. Customizing the number o f sessions and providing periodic reinforcement may improve the succes s rate.