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Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence.
Am J Gastroenterol. 2002 Jan; 97(1):109-17.AJ

Abstract

OBJECTIVES

Biofeedback is a nonsurgical treatment that reportedly produces good results in 65-75% of fecally incontinent patients. However, previous studies have not ruled out nonspecific treatment effects. It is also unknown whether biofeedback works primarily by improving the strength of the striated pelvic floor muscles or by improving the rectal perception. We aimed to 1) evaluate the efficacy of biofeedback in formed-stool fecal incontinence, 2) assess the relative contribution of sensory and strength retraining to biofeedback outcomes, and 3) identify patient characteristics that predict a good response to treatment.

METHODS

Twenty-four patients with frequent (at least once a week) solid-stool incontinence were provided with three to four biofeedback sessions. They were taught to squeeze in response to progressively weaker rectal distentions. Patients were re-evaluated by anorectal manometry and symptom diary 3 months after completing training and by diary and interview 6-12 months after training.

RESULTS

Seventeen (71%) were classified responders; 13 became continent and four reduced incontinence frequency by at least 75%. Clinical improvements were maintained at 12-month follow-up. At 3-month follow-up, responders had significantly lower thresholds for perception of rectal distention and for sphincter contraction, but squeeze pressures did not significantly differ from those of nonresponders. Baseline measures that predicted a favorable response were sensory threshold (50 ml or less), urge threshold (100 ml or less), lower threshold for sphincter contraction, and lower threshold for the rectoanal inhibitory reflex; neither anal squeeze pressure nor severity of incontinence predicted treatment outcome.

CONCLUSIONS

In solid-stool fecal incontinence biofeedback training effects are robust and seem not to be explained by expectancy or nonspecific treatment effect. Sensory retraining appears to be more relevant than strength training to the success of biofeedback.

Authors+Show Affiliations

Divisione di Riabilitazione Gastroenterologica, Universitá di Verona, Azienda Ospedaliera di Verona, Centro Ospedaliero Clinicizzato, Valeggio sul Mincio, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11808933

Citation

Chiarioni, G, et al. "Sensory Retraining Is Key to Biofeedback Therapy for Formed Stool Fecal Incontinence." The American Journal of Gastroenterology, vol. 97, no. 1, 2002, pp. 109-17.
Chiarioni G, Bassotti G, Stanganini S, et al. Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. Am J Gastroenterol. 2002;97(1):109-17.
Chiarioni, G., Bassotti, G., Stanganini, S., Vantini, I., Whitehead, W. E., & Stegagnini, S. (2002). Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. The American Journal of Gastroenterology, 97(1), 109-17.
Chiarioni G, et al. Sensory Retraining Is Key to Biofeedback Therapy for Formed Stool Fecal Incontinence. Am J Gastroenterol. 2002;97(1):109-17. PubMed PMID: 11808933.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. AU - Chiarioni,G, AU - Bassotti,G, AU - Stanganini,Samuela, AU - Vantini,I, AU - Whitehead,W E, AU - Stegagnini,Samuela, PY - 2002/1/26/pubmed PY - 2002/2/8/medline PY - 2002/1/26/entrez SP - 109 EP - 17 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 97 IS - 1 N2 - OBJECTIVES: Biofeedback is a nonsurgical treatment that reportedly produces good results in 65-75% of fecally incontinent patients. However, previous studies have not ruled out nonspecific treatment effects. It is also unknown whether biofeedback works primarily by improving the strength of the striated pelvic floor muscles or by improving the rectal perception. We aimed to 1) evaluate the efficacy of biofeedback in formed-stool fecal incontinence, 2) assess the relative contribution of sensory and strength retraining to biofeedback outcomes, and 3) identify patient characteristics that predict a good response to treatment. METHODS: Twenty-four patients with frequent (at least once a week) solid-stool incontinence were provided with three to four biofeedback sessions. They were taught to squeeze in response to progressively weaker rectal distentions. Patients were re-evaluated by anorectal manometry and symptom diary 3 months after completing training and by diary and interview 6-12 months after training. RESULTS: Seventeen (71%) were classified responders; 13 became continent and four reduced incontinence frequency by at least 75%. Clinical improvements were maintained at 12-month follow-up. At 3-month follow-up, responders had significantly lower thresholds for perception of rectal distention and for sphincter contraction, but squeeze pressures did not significantly differ from those of nonresponders. Baseline measures that predicted a favorable response were sensory threshold (50 ml or less), urge threshold (100 ml or less), lower threshold for sphincter contraction, and lower threshold for the rectoanal inhibitory reflex; neither anal squeeze pressure nor severity of incontinence predicted treatment outcome. CONCLUSIONS: In solid-stool fecal incontinence biofeedback training effects are robust and seem not to be explained by expectancy or nonspecific treatment effect. Sensory retraining appears to be more relevant than strength training to the success of biofeedback. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11808933/Sensory_retraining_is_key_to_biofeedback_therapy_for_formed_stool_fecal_incontinence_ L2 - https://Insights.ovid.com/pubmed?pmid=11808933 DB - PRIME DP - Unbound Medicine ER -