Biofeedback for fecal incontinence using transanal ultrasonography - Novelapproach

PURPOSE: Neosphincter procedures may prove to be the treatment of choice fo r patients with neuropathic fecal incontinence but are rarely proposed for milder forms of the disease. Biofeedback may prove beneficial to these pati ents but is yet unproven. The objectives of this study were to develop a me thod of performing biofeedback using transanal ultrasound to teach the pati ent to contract repetitively and to determine biologic measures of sphincte r function using transanal ultrasound in healthy and incontinent patients. METHODS: Initial uncontrolled studies were performed to determine the compl iance, normal values, biologic measures of external sphincter strength (iso tonic and isometric fatigue times), and early efficacy data using continenc e scores and visual analog scale scores. RESULTS: Forty-four patients were assessed during three months, with relative improvements in continence scor es (St. Mark's Hospital, 40 percent; Pescatori, 20 percent) and patient and investigator visual analog scale scores (38 percent for both) and measurab le increase in biologic fatigue times measured by transanal ultrasound. CON CLUSIONS: Transanal ultrasound seems to be a method of teaching external sp hincter contraction and measuring sphincter strength with good initial comp liance. Clinically and statistically significant improvements in incontinen ce scores, visual analog scale scores, and biologic strength of the externa l sphincter were detected in the short-term follow-up with uncontrolled dat a. The randomized, controlled trial that we have begun will either confirm or refute these results.