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Biofeedback for fecal incontinence: a randomized study comparing exercise regimens.
Dis Colon Rectum. 2011 Jul; 54(7):846-56.DC

Abstract

BACKGROUND

Fecal incontinence affects up to 11% of Australian community-dwelling adults and 72% of nursing home residents. Biofeedback is a recommended conservative therapy when medication and pelvic floor exercises have failed to improve patient outcomes.

OBJECTIVE

This study aimed to investigate the impact of a new exercise regimen on the severity of fecal incontinence and the quality of life of participants.

DESIGN

This was a randomized clinical study.

SETTINGS

This study was conducted at the Anorectal Physiology Clinic, Townsville Hospital, Queensland, Australia.

PATIENTS

Seventy-two participants (19 male), with a mean age of 62.1 years, attended 5 clinic sessions: 4 weekly sessions followed by 4 weeks of home practice and a follow-up assessment session. A postal survey was conducted 2 years later.

INTERVENTION

Thirty-seven patients (12 male) were randomly assigned to the standard clinical protocol (sustained submaximal anal and pelvic floor exercises) and 35 patients (7 male) were randomly assigned to the alternative group (rapid squeeze plus sustained submaximal exercises).

MAIN OUTCOME MEASURES

The main outcomes were measured by use of the Cleveland Clinic Florida Fecal Incontinence score and the Fecal Incontinence Quality of Life Scale survey tool.

RESULTS

No significant differences were found between the 2 exercise groups at the beginning or at the end of the study or as a result of treatment in objective, quality-of-life, or fecal incontinence severity measures. Sixty-nine participants completed treatment. The severity of fecal incontinence decreased significantly (11.5/20 to 5.0/20, P < .001). Eighty-six percent (59/69) of participants reported improved continence. Quality of life significantly improved for all participants (P < .001). Results were sustained 2 years later. Patients who practiced at least the prescribed number of exercises had better outcomes than those who practiced fewer exercises.

LIMITATIONS

This study was limited because it involved a heterogeneous sample, it was based on subjective reporting of exercise performance, and loss to follow-up occurred because of the highly mobile population.

CONCLUSIONS

Patients attending this biofeedback program attained significant improvement in the severity of their fecal incontinence and in their quality of life. Although introduction of rapid muscle squeezes had little impact on fecal incontinence severity or patient quality of life, patient exercise compliance at prescribed or greater levels did.

Authors+Show Affiliations

School of Public Health, Tropical Medicine & Rehabilitation Science, North Queensland Centre for Cancer Research, James Cook University, Townsville, Australia. lynne.bartlett@my.jcu.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21654252

Citation

Bartlett, Lynne, et al. "Biofeedback for Fecal Incontinence: a Randomized Study Comparing Exercise Regimens." Diseases of the Colon and Rectum, vol. 54, no. 7, 2011, pp. 846-56.
Bartlett L, Sloots K, Nowak M, et al. Biofeedback for fecal incontinence: a randomized study comparing exercise regimens. Dis Colon Rectum. 2011;54(7):846-56.
Bartlett, L., Sloots, K., Nowak, M., & Ho, Y. H. (2011). Biofeedback for fecal incontinence: a randomized study comparing exercise regimens. Diseases of the Colon and Rectum, 54(7), 846-56. https://doi.org/10.1007/DCR.0b013e3182148fef
Bartlett L, et al. Biofeedback for Fecal Incontinence: a Randomized Study Comparing Exercise Regimens. Dis Colon Rectum. 2011;54(7):846-56. PubMed PMID: 21654252.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biofeedback for fecal incontinence: a randomized study comparing exercise regimens. AU - Bartlett,Lynne, AU - Sloots,Kathryn, AU - Nowak,Madeleine, AU - Ho,Yik-Hong, PY - 2011/6/10/entrez PY - 2011/6/10/pubmed PY - 2011/8/13/medline SP - 846 EP - 56 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 54 IS - 7 N2 - BACKGROUND: Fecal incontinence affects up to 11% of Australian community-dwelling adults and 72% of nursing home residents. Biofeedback is a recommended conservative therapy when medication and pelvic floor exercises have failed to improve patient outcomes. OBJECTIVE: This study aimed to investigate the impact of a new exercise regimen on the severity of fecal incontinence and the quality of life of participants. DESIGN: This was a randomized clinical study. SETTINGS: This study was conducted at the Anorectal Physiology Clinic, Townsville Hospital, Queensland, Australia. PATIENTS: Seventy-two participants (19 male), with a mean age of 62.1 years, attended 5 clinic sessions: 4 weekly sessions followed by 4 weeks of home practice and a follow-up assessment session. A postal survey was conducted 2 years later. INTERVENTION: Thirty-seven patients (12 male) were randomly assigned to the standard clinical protocol (sustained submaximal anal and pelvic floor exercises) and 35 patients (7 male) were randomly assigned to the alternative group (rapid squeeze plus sustained submaximal exercises). MAIN OUTCOME MEASURES: The main outcomes were measured by use of the Cleveland Clinic Florida Fecal Incontinence score and the Fecal Incontinence Quality of Life Scale survey tool. RESULTS: No significant differences were found between the 2 exercise groups at the beginning or at the end of the study or as a result of treatment in objective, quality-of-life, or fecal incontinence severity measures. Sixty-nine participants completed treatment. The severity of fecal incontinence decreased significantly (11.5/20 to 5.0/20, P < .001). Eighty-six percent (59/69) of participants reported improved continence. Quality of life significantly improved for all participants (P < .001). Results were sustained 2 years later. Patients who practiced at least the prescribed number of exercises had better outcomes than those who practiced fewer exercises. LIMITATIONS: This study was limited because it involved a heterogeneous sample, it was based on subjective reporting of exercise performance, and loss to follow-up occurred because of the highly mobile population. CONCLUSIONS: Patients attending this biofeedback program attained significant improvement in the severity of their fecal incontinence and in their quality of life. Although introduction of rapid muscle squeezes had little impact on fecal incontinence severity or patient quality of life, patient exercise compliance at prescribed or greater levels did. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/21654252/Biofeedback_for_fecal_incontinence:_a_randomized_study_comparing_exercise_regimens_ L2 - http://dx.doi.org/10.1007/DCR.0b013e3182148fef DB - PRIME DP - Unbound Medicine ER -