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Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence.

Abstract

PURPOSE

This study aimed to compare manometric biofeedback with pelvic floor exercises for the treatment of fecal incontinence in a randomized controlled trial controlling for nonspecific treatment effects.

METHODS

After excluding patients who were adequately treated with medication, education, and behavioral strategies (21%), 108 patients (83 females; average age, 59.6 years) underwent either pelvic floor exercises alone (n = 63) or manometric biofeedback plus pelvic floor exercises (n = 45). Patients in both groups were taught behavioral strategies to avoid incontinence.

RESULTS

At three-month follow-up, biofeedback patients had significantly greater reductions on the Fecal Incontinence Severity Index (P = 0.01) and fewer days with fecal incontinence (P = 0.083). Biofeedback training increased anal canal squeeze pressure more than pelvic floor exercises did (P = 0.014) and with less abdominal tension during squeeze (P = 0.001). Three months after training 76% of patients treated with biofeedback vs. 41% patients treated with pelvic floor exercises (chi-squared = 12.5, P < 0.001) reported adequate relief. Before treatment, the groups did not differ on demographic, physiologic, or psychologic variables, symptom severity, duration of illness, quality-of-life impact, or expectation of benefit. At 12-month follow-up, biofeedback patients continued to show significantly greater reduction in Fecal Incontinence Severity Index scores (F = 4.83, P = 0.03), and more patients continued to report adequate relief (chi-squared = 3.64, P = 0.056).

CONCLUSION

This investigation provides definitive support for the efficacy of biofeedback. Biofeedback training resulted in greater reductions in fecal incontinence severity and days with fecal incontinence. Biofeedback was also more effective than pelvic floor exercises alone in producing adequate relief of fecal incontinence symptoms in patients for whom conservative medical management had failed.

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  • Authors+Show Affiliations

    ,

    Department of Medicine (Division of Gastroenterology and Hepatology) and Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina 27599-7080, USA. steve_heymen@med.unc.edu

    , , , ,

    Source

    Diseases of the colon and rectum 52:10 2009 Oct pg 1730-7

    MeSH

    Analysis of Variance
    Biofeedback, Psychology
    Chi-Square Distribution
    Electromyography
    Exercise Therapy
    Fecal Incontinence
    Female
    Humans
    Male
    Manometry
    Middle Aged
    Pelvic Floor
    Quality of Life
    Severity of Illness Index
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19966605

    Citation

    Heymen, Steve, et al. "Randomized Controlled Trial Shows Biofeedback to Be Superior to Pelvic Floor Exercises for Fecal Incontinence." Diseases of the Colon and Rectum, vol. 52, no. 10, 2009, pp. 1730-7.
    Heymen S, Scarlett Y, Jones K, et al. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum. 2009;52(10):1730-7.
    Heymen, S., Scarlett, Y., Jones, K., Ringel, Y., Drossman, D., & Whitehead, W. E. (2009). Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Diseases of the Colon and Rectum, 52(10), pp. 1730-7. doi:10.1007/DCR.0b013e3181b55455.
    Heymen S, et al. Randomized Controlled Trial Shows Biofeedback to Be Superior to Pelvic Floor Exercises for Fecal Incontinence. Dis Colon Rectum. 2009;52(10):1730-7. PubMed PMID: 19966605.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. AU - Heymen,Steve, AU - Scarlett,Yolanda, AU - Jones,Kenneth, AU - Ringel,Yehuda, AU - Drossman,Douglas, AU - Whitehead,William E, PY - 2009/12/8/entrez PY - 2009/12/8/pubmed PY - 2010/1/27/medline SP - 1730 EP - 7 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 52 IS - 10 N2 - PURPOSE: This study aimed to compare manometric biofeedback with pelvic floor exercises for the treatment of fecal incontinence in a randomized controlled trial controlling for nonspecific treatment effects. METHODS: After excluding patients who were adequately treated with medication, education, and behavioral strategies (21%), 108 patients (83 females; average age, 59.6 years) underwent either pelvic floor exercises alone (n = 63) or manometric biofeedback plus pelvic floor exercises (n = 45). Patients in both groups were taught behavioral strategies to avoid incontinence. RESULTS: At three-month follow-up, biofeedback patients had significantly greater reductions on the Fecal Incontinence Severity Index (P = 0.01) and fewer days with fecal incontinence (P = 0.083). Biofeedback training increased anal canal squeeze pressure more than pelvic floor exercises did (P = 0.014) and with less abdominal tension during squeeze (P = 0.001). Three months after training 76% of patients treated with biofeedback vs. 41% patients treated with pelvic floor exercises (chi-squared = 12.5, P < 0.001) reported adequate relief. Before treatment, the groups did not differ on demographic, physiologic, or psychologic variables, symptom severity, duration of illness, quality-of-life impact, or expectation of benefit. At 12-month follow-up, biofeedback patients continued to show significantly greater reduction in Fecal Incontinence Severity Index scores (F = 4.83, P = 0.03), and more patients continued to report adequate relief (chi-squared = 3.64, P = 0.056). CONCLUSION: This investigation provides definitive support for the efficacy of biofeedback. Biofeedback training resulted in greater reductions in fecal incontinence severity and days with fecal incontinence. Biofeedback was also more effective than pelvic floor exercises alone in producing adequate relief of fecal incontinence symptoms in patients for whom conservative medical management had failed. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/19966605/Randomized_controlled_trial_shows_biofeedback_to_be_superior_to_pelvic_floor_exercises_for_fecal_incontinence_ L2 - http://Insights.ovid.com/pubmed?pmid=19966605 DB - PRIME DP - Unbound Medicine ER -