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Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence.
Dis Colon Rectum. 1999 Jun; 42(6):762-9.DC

Abstract

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 of 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

Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29-74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external 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 of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy.

CONCLUSION

In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.

Authors+Show Affiliations

Groupe de Recherche sur l'Appareil Digestif, Hôpital Charles Nicolle, Rouen, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10378600

Citation

Leroi, A M., et al. "Pudendal Neuropathy and Severity of Incontinence but Not Presence of an Anal Sphincter Defect May Determine the Response to Biofeedback Therapy in Fecal Incontinence." Diseases of the Colon and Rectum, vol. 42, no. 6, 1999, pp. 762-9.
Leroi AM, Dorival MP, Lecouturier MF, et al. Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum. 1999;42(6):762-9.
Leroi, A. M., Dorival, M. P., Lecouturier, M. F., Saiter, C., Welter, M. L., Touchais, J. Y., & Denis, P. (1999). Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Diseases of the Colon and Rectum, 42(6), 762-9.
Leroi AM, et al. Pudendal Neuropathy and Severity of Incontinence but Not Presence of an Anal Sphincter Defect May Determine the Response to Biofeedback Therapy in Fecal Incontinence. Dis Colon Rectum. 1999;42(6):762-9. PubMed PMID: 10378600.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. AU - Leroi,A M, AU - Dorival,M P, AU - Lecouturier,M F, AU - Saiter,C, AU - Welter,M L, AU - Touchais,J Y, AU - Denis,P, PY - 1999/6/23/pubmed PY - 1999/6/23/medline PY - 1999/6/23/entrez SP - 762 EP - 9 JF - Diseases of the colon and rectum JO - Dis Colon Rectum VL - 42 IS - 6 N2 - 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 of 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: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29-74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external 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 of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy. CONCLUSION: In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/10378600/Pudendal_neuropathy_and_severity_of_incontinence_but_not_presence_of_an_anal_sphincter_defect_may_determine_the_response_to_biofeedback_therapy_in_fecal_incontinence_ L2 - http://link.springer.com/article/10.1007/BF02236932 DB - PRIME DP - Unbound Medicine ER -