PROSPECTIVE TRIAL OF PELVIC FLOOR RETRAINING IN PATIENTS WITH FECAL INCONTINENCE

PURPOSE: Our aim was to prospectively evaluate pelvic floor retraining (PFR) in improving symptomatic fecal incontinence. METHODS: PFR was u sed to treat 30 patients with fecal incontinence (28 women; age range, 29-85 (median, 68) years). PFR was performed by a physiotherapist in the outpatient department according to a strict protocol and included biofeedback using an anal plug electromyometer. Manometry (24 patients ), pudendal nerve terminal motor latency (PNTML, 16 patients), and ana l ultrasound (14 patients) were done before commencing therapy. Indepe ndent assessment of symptoms was done at the commencement of therapy, at 6 weeks, and at 6 and 12 months posttherapy. RESULTS: Twenty patien ts (67 percent) had improved incontinence scores, with eight patients (27 percent) being completely or nearly free of symptoms. Of 28 patien ts followed up longer than six months, 14 achieved a 25 percent or gre ater improvement at six weeks, which was sustained in all cases. Fourt een had an initial improvement of less than 25 percent, with only four (29 percent) showing later improvement (P < 0.0001). There was no rel ationship between results of the therapy and patient age, initial seve rity of symptoms, etiology of incontinence, and results of anal manome try, PNTML, and anal ultrasound. CONCLUSIONS: PFR is a physical therap y that should be considered as the initial treatment in patients with fecal incontinence. An improvement can be expected in up to 67 percent of patients. Initial good results can predict overall outcome.