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Randomized controlled trial of biofeedback for fecal incontinence.
Gastroenterology. 2003 Nov; 125(5):1320-9.G

Abstract

BACKGROUND & AIMS

Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care.

METHODS

A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry.

RESULTS

Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment.

CONCLUSIONS

Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education.

Authors+Show Affiliations

St. Mark's Hospital, Northwick Park, Watford Road, Harrow HA 1 3UJ, England, UK. csnorton@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14598248

Citation

Norton, Christine, et al. "Randomized Controlled Trial of Biofeedback for Fecal Incontinence." Gastroenterology, vol. 125, no. 5, 2003, pp. 1320-9.
Norton C, Chelvanayagam S, Wilson-Barnett J, et al. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2003;125(5):1320-9.
Norton, C., Chelvanayagam, S., Wilson-Barnett, J., Redfern, S., & Kamm, M. A. (2003). Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology, 125(5), 1320-9.
Norton C, et al. Randomized Controlled Trial of Biofeedback for Fecal Incontinence. Gastroenterology. 2003;125(5):1320-9. PubMed PMID: 14598248.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized controlled trial of biofeedback for fecal incontinence. AU - Norton,Christine, AU - Chelvanayagam,Sonya, AU - Wilson-Barnett,Jenifer, AU - Redfern,Sally, AU - Kamm,Michael A, PY - 2003/11/5/pubmed PY - 2003/12/16/medline PY - 2003/11/5/entrez SP - 1320 EP - 9 JF - Gastroenterology JO - Gastroenterology VL - 125 IS - 5 N2 - BACKGROUND & AIMS: Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care. METHODS: A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry. RESULTS: Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment. CONCLUSIONS: Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education. SN - 0016-5085 UR - https://www.unboundmedicine.com/medline/citation/14598248/Randomized_controlled_trial_of_biofeedback_for_fecal_incontinence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016508503013684 DB - PRIME DP - Unbound Medicine ER -