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Biofeedback treatment of fecal incontinence: a critical review.

Abstract

PURPOSE

The aims of this review are 1) to critically evaluate the literature on the efficacy of biofeedback treatment for fecal incontinence, 2) to compare different types of biofeedback, and 3) to identify patient characteristics which predict a successful outcome.

METHODS

The MEDLINE database was searched for articles published between 1973 and 1999 which included the terms "biofeedback" and "fecal incontinence." Pediatric and adult articles in any language were screened. Inclusion for review required that the study be prospective, have five or more subjects, and have a description of the treatment protocol.

RESULTS

Thirty-five studies were reviewed. Only six studies used a parallel treatment design and just three of those randomized subjects to treatment groups. A meta-analysis (weighted by subjects) was performed to compare the results of two treatment protocols that dominate the literature. The mean success rate of studies using Coordination training (i.e., coordinating pelvic floor muscle contraction with the sensation of rectal filling) was 67 percent, while the mean success rate for studies using Strength training (i.e., pelvic floor muscle contraction) was 70 percent. Furthermore, the mean success rate for those Strength training studies using electromyographic biofeedback was 74 percent, while the mean success rate for studies using anal canal pressure biofeedback Strength training was 64 percent. However, these conclusions are limited by the absence of clearly identified criteria for determining success. There are also inconsistencies in the literature regarding the patient selection criteria, severity and cause of symptoms, amount of treatment, as well as the type of biofeedback protocols and instrumentation used. Finally, no patient characteristics were identified that would assist in predicting successful outcome.

CONCLUSION

Although most studies report positive results using biofeedback to treat fecal incontinence, quality research is lacking. Recommendations are made for future investigations to 1) improve experimental design, 2) include long term follow-up data, and 3) to use an adequate sample size that allows for meaningful analysis.

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  • Authors+Show Affiliations

    ,

    Center for Functional Gastrointestinal and Motility Disorders, Department of Medicine, The University of North Carolina, Chapel Hill 27599-7080, USA.

    , , ,

    Source

    Diseases of the colon and rectum 44:5 2001 May pg 728-36

    MeSH

    Adult
    Anal Canal
    Biofeedback, Psychology
    Child
    Electromyography
    Fecal Incontinence
    Humans
    Muscle Weakness
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    11357037

    Citation

    Heymen, S, et al. "Biofeedback Treatment of Fecal Incontinence: a Critical Review." Diseases of the Colon and Rectum, vol. 44, no. 5, 2001, pp. 728-36.
    Heymen S, Jones KR, Ringel Y, et al. Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum. 2001;44(5):728-36.
    Heymen, S., Jones, K. R., Ringel, Y., Scarlett, Y., & Whitehead, W. E. (2001). Biofeedback treatment of fecal incontinence: a critical review. Diseases of the Colon and Rectum, 44(5), pp. 728-36.
    Heymen S, et al. Biofeedback Treatment of Fecal Incontinence: a Critical Review. Dis Colon Rectum. 2001;44(5):728-36. PubMed PMID: 11357037.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Biofeedback treatment of fecal incontinence: a critical review. AU - Heymen,S, AU - Jones,K R, AU - Ringel,Y, AU - Scarlett,Y, AU - Whitehead,W E, PY - 2001/5/18/pubmed PY - 2001/6/8/medline PY - 2001/5/18/entrez SP - 728 EP - 36 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 44 IS - 5 N2 - PURPOSE: The aims of this review are 1) to critically evaluate the literature on the efficacy of biofeedback treatment for fecal incontinence, 2) to compare different types of biofeedback, and 3) to identify patient characteristics which predict a successful outcome. METHODS: The MEDLINE database was searched for articles published between 1973 and 1999 which included the terms "biofeedback" and "fecal incontinence." Pediatric and adult articles in any language were screened. Inclusion for review required that the study be prospective, have five or more subjects, and have a description of the treatment protocol. RESULTS: Thirty-five studies were reviewed. Only six studies used a parallel treatment design and just three of those randomized subjects to treatment groups. A meta-analysis (weighted by subjects) was performed to compare the results of two treatment protocols that dominate the literature. The mean success rate of studies using Coordination training (i.e., coordinating pelvic floor muscle contraction with the sensation of rectal filling) was 67 percent, while the mean success rate for studies using Strength training (i.e., pelvic floor muscle contraction) was 70 percent. Furthermore, the mean success rate for those Strength training studies using electromyographic biofeedback was 74 percent, while the mean success rate for studies using anal canal pressure biofeedback Strength training was 64 percent. However, these conclusions are limited by the absence of clearly identified criteria for determining success. There are also inconsistencies in the literature regarding the patient selection criteria, severity and cause of symptoms, amount of treatment, as well as the type of biofeedback protocols and instrumentation used. Finally, no patient characteristics were identified that would assist in predicting successful outcome. CONCLUSION: Although most studies report positive results using biofeedback to treat fecal incontinence, quality research is lacking. Recommendations are made for future investigations to 1) improve experimental design, 2) include long term follow-up data, and 3) to use an adequate sample size that allows for meaningful analysis. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/11357037/Biofeedback_treatment_of_fecal_incontinence:_a_critical_review_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=11357037.ui DB - PRIME DP - Unbound Medicine ER -