BIOFEEDBACK FOR THE TREATMENT OF FECAL INCONTINENCE - LONG-TERM CLINICAL-RESULTS

Biofeedback therapy has been proposed as a treatment for fetal inconti nence with good, short-term results. PURPOSE: This study was designed to assess long-term clinical results of biofeedback therapy compared w ith medical therapy alone and to assess manometric results in patients treated with biofeedback. METHODS: Two groups of incontinent patients were studied. Group 1 consisted of 16 patients (3 males and 13 female s; mean age, 59.9 years). Etiologies treated by biofeedback included d escending perineum syndrome (7), postfistula or hemorroidectomy (4), a nd miscellaneous (5). Group 2 consisted of eight patients (two males, six females; mean age, 62.2 years). Etiologies treated with medical tr eatment alone (including enema and antidiarrheal therapy) included des cending perineum syndrome (3), postfistula or hemorroidectomy (2), and miscellaneous (3). The incontinence score was initially 17.81 +/- 3.2 7 (standard deviation) in Group 1 and 17.0 +/- 2.77 in Group 2. Restin g pressure of the upper and lower anal sphincter, maximum squeezing pr essure, and duration of contraction were not initially different in Gr oups 1 and 2 but were significantly lower than in the control group of patients without incontinence (n = 12; 8 males, 4 females; mean age, 66.4 years) (P < 0.05). Follow-up duration was 30 months, with interme diate clinical score at 6 months for Group 1. RESULTS: After biofeedba ck therapy, the incontinence score at 30 months was lower in Group 1 ( 14.43 +/- 6.35 vs. 17.81 +/- 3.27; P < 0.035) and unchanged in Group 2 (18.0 +/- 2.72 us. 17.0 +/- 2.77). However, in Group 1 the score at 6 months was much lower than at 30 months (6.31 +/- 7.81 vs. 14.43 +/- 6.35; P < 0.001). Only the amplitude of voluntary contraction and uppe r anal pressure (51.1 (range, 27-90) vs 36.7 (range, 20-80) mmHg) were significantly increased (81.5 (range, 55-120) us. 62.1 (range, 30-90) mmHg; P < 0.05). CONCLUSION: Biofeedback improved continence at 6 mon ths and at 30 months. However, the score at 6 months was much better, suggesting that the initial good results may deteriorate over a long t ime. These data suggest that it could be useful to reinitiate biofeedb ack therapy in some patients.