BIOFEEDBACK IMPROVES FUNCTIONAL OUTCOME AFTER SPHINCTEROPLASTY

The primary treatment for obstetric sphincter injury is overlapping sp hincteroplasty. However, despite restoration of the anatomy, only 65 p ercent of patients are fully continent. PURPOSE: This study was undert aken to determine if postoperative biofeedback improved continence in patients with poor functional outcomes after sphincteroplasty. METHOD: Outcomes of 28 patients who underwent electromyographic biofeedback t raining after sphincteroplasty for obstetric sphincter injury were rev iewed. Nine patients had an accompanying levatorplasty. Average age wa s 34 (range, 23-57) years. Patients began biofeedback a mean of 32 (ra nge, 2-192) months postoperatively. Before beginning biofeedback, pati ents completed an incontinence questionnaire, bowel diary, and scored their incontinence. At thr end of treatment, they were again asked to score their incontinence and rate their improvement. Using an incontin ence scale with a maximum score of 30, the average incontinence score before biofeedback was 20 (range, 13-30). Incontinent episodes per wee k ranged from one to nine. Sixteen patients were incontinent to solid stool. RESULTS: Overall, the average posttreatment incontinence score decreased from 20 to 3 (P < 0.0001). Average number of incontinent epi sodes per week decreased from 5.4 to 1.4 (P < 0.0001) Twenty-five pati ents (89 percent) reported improvement in their continence. All had a posttreatment incontinent score of less than three. Three patients not ed no improvement. Of those, one subsequently had a colostomy, one is waiting the implant of an artificial anal sphincter, and one has sough t no further treatment. There were no complications reported. CONCLUSI ON: Biofeedback improves functional outcome after sphincteroplasty and is a reasonable option for patients with less than optimum outcome af ter sphincteroplasty.