Long-term results of electromyographic biofeedback training for fecal incontinence

PURPOSE: The aim of this study was to examine the longterm results of elect romyographic biofeedback training in fecal incontinence. METHODS: Thirty-se ven patients (1 male) received a customised program of 2 to 11 (median, 3) biofeedback training sessions with an anal plug electromyometer. Nine patie nts had persistent incontinence after anal sphincter repair, a further 8 pa tients had postsurgical or partial obstetric damage of the sphincter but no sphincter repair, 9 patients had neurogenic sphincter damage, and 11 patie nts were classified as having idiopathic fecal incontinence. Duration of vo luntary sphincter contraction was measured by anal electromyography (endura nce score before and after treatment. A postal questionnaire was used to in vestigate the following variables: 1) subjective rating on a four-grade Lik ert-scale of the overall result of the biofeedback training; 2) incontinenc e score (maximum score is 18, and 0 indicates no incontinence); and 3) rati ng of bowel dissatisfaction using a visual analog scale (0 to 10). RESULTS: Twenty-two patients (60 percent) rated the result as very good (n = 8) or good (n = 14) immediately after the treatment period. Median endurance scor e improved from 1 to 2 minutes (P < 0.0001). Median incontinence score impr oved from 11 to 7, and bowel dissatisfaction rating improved from 5 to 2.8 (both P < 0.0001). After a median follow-up of 44 (range, 12-53) months, 15 patients (41 percent) still rated the overall result as very good (n = 3) or good (n = 12). The incontinence score did not change during follow-up. M edian bowel dissatisfaction rating deteriorated from 2.8 to 4.2 but remaine d better than before treatment. Poor early subjective rating and the need f or more than three biofeedback sessions were predictive of worsening during follow-up. CONCLUSION: We think it is encouraging that in this study biofe edback treatment for fecal incontinence with an intra-anal plug electrode r esulted in a long-term success rare in nearly one-half of the patients.