The purpose of this prospective study was to see if pretreatment anore
ctal motility can predict successful correction of faecal incontinence
with biofeedback. Forty-seven consecutive children, aged 5 to 18 year
s, were treated. They had been treated for idiopathic constipation wit
h faecal impaction, but had remained incontinent (n = 15), had been op
erated for congenital anorectal malformations of high (n = 19) or low
(n = 2) type, or had a number of organic congenital pelvic abnormaliti
es (n = 11). This consecutive series represents our entire experience
with biofeedback for faecal incontinence, in the period from January 1
1983 to December 31 1989. In each patient, at the first session, anor
ectal manometry was performed. Resting pressures in the rectum, upper
anal canal and lower anal canal were measured. The threshold of rectal
sensation during distension, the maximal pressure during voluntary sp
hincteric contraction and the time to half decrease of sphincteric pre
ssure because of muscular fatigue were also noted. The patient was the
n asked to make a voluntary sphincteric contraction, while the rectum
was being distended with the volume at threshold for rectal sensation.
In subsequent sessions, the rectum was also distended but without war
ning the patient, who was congratulated when he or she contracted the
sphincter immediately after onset of rectal distension. Full continenc
e was the criterion used to classify re-education as a success. Improv
ement or no change in continence was considered as failure of the trea
tment. Three parameters only improved after treatment: the threshold f
or rectal sensation which decreased (P < 0.05), the maximal peak of vo
luntary contraction which increased (P < 0.001), and the duration of t
his contraction which was prolonged (P < 0.05). Patients who were to r
ecover had, before treatment, lower threshold of rectal sensation (P <
0.01), higher maximum voluntary contraction of the anal sphincter (P
< 0.05), and tended to have a higher resting tone in the anal canal (P
= 0.07). In addition, after biofeedback treatment, the decrease of th
reshold for rectal sensation (P < 0.05), increase of maximal voluntary
contraction (P < 0.005) and maintained contractions (P < 0.05) were m
ore important in patients who became continent than in those who remai
ned incontinent. Fifty per cent of the patients were cured from faecal
incontinence by biofeedback re-education. Success was much higher in
patients initially seen for constipation and faecal incontinence (92%)
than in the other patients (35%) (P < 0.01). Patients with constipati
on had higher pressures in the upper anal canal, in addition to better
voluntary contraction, and lower threshold of rectal sensation, both
before and after treatment, than patients with other disorders. It is
concluded that there is a correlation between cure from faecal inconti
nence and improvement in anorectal sensitive and dynamic parameters bu
t that this may largely be due to the underlying disorder.