Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence

PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity o f fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedb ack therapy was used to treat 27 patients with fecal incontinence (25 women ; mean age, 53; range, 29-74 years), according to a strict protocol. Manome try, pudendal nerve terminal motor latency, and anal ultrasound were perfor med in all patients before biofeedback therapy. Manometric evaluation of ex ternal anal sphincter function was performed after the biofeedback sessions . RESULTS: Eight of 27 patients had a good clinical response to biofeedback , but with no significant difference in their mean amplitude and duration o f squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severit y of fecal incontinence, pudendal neuropathy or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neu ropathy failed to improve the amplitude and duration of their maximum volun tary contraction after biofeedback therapy. Patients with mild fecal incont inence (incontinence to flatus, liquids, or both) (P < 0.04), without puden dal neuropathy (P < 0.02), or with (P < 0.05) and without (P < 0.05) extern al sphincter defect improved their external anal sphincter function after b iofeedback therapy. CONCLUSION: In patients with fecal incontinence, the se verity of symptoms and pudendal neuropathy should be considered as two fact ors of poor prognosis of favorable manometric results after biofeedback the rapy. Improvement, on the other hand, may be expected after biofeedback the rapy despite an external anal sphincter defect.