BIOFEEDBACK IN COLORECTAL PRACTICE - A MULTICENTER, STATEWIDE, 3-YEAREXPERIENCE

PURPOSE: Biofeedback treatment is often offered to patients in colorec tal centers; however, standards of treatment are still lacking. A dedi cated team approach is desirable but difficult to coordinate. We prese nt our three-year experience of electromyographic-based biofeedback tr eatment offered within a multicenter, statewide organization. METHODS: Between October 1992 and October 1995, 188 patients completed a biofe edback treatment program in one of five coordinated centers within a 2 00-mile radius. A unified common database was established and continuo usly updated. A colorectal surgeon served as statewide director, and d edicated teams were established at each location. Each local team incl uded the medical director and a certified biofeedback therapist and ha d access to a dietitian and a nurse data coordinator. Electromyographi c-based biofeedback sessions were given weekly, and a home trainer pro gram was established. RESULTS: A total of 116 patients with chronic co nstipation had a mean of eight (range, 2-14) weekly sessions. A total of 72 patients with fecal incontinence had a mean of seven (range, 2-1 1) weekly sessions. A total of 84 percent of the constipated and 85 pe rcent of the incontinent patients had significant improvement with bio feedback treatment. Patient compliance and satisfaction were high. Con stipated patients increased the mean number of weekly unassisted bowel movements from 0.8 to 6.5. Incontinent patients decreased the mean nu mber of weekly gross incontinence episodes from 11.8 to 2. CONCLUSIONS : Biofeedback treatment can be extremely successful in both incontinen t and constipated patients. A large geographic area can be covered wit h coordinated centers in which each dedicated team uses a unified trea tment protocol, and a common database is established.