Effect of biofeedback and electrostimulation on sphincter function in fecal incontinence

Abstract

The following study reports on the effect of biofeedback and transanal electric stimulation as a conservative method in the therapy of idiopathic fecal incontinence. 22 consecutive patients in whom the diagnosis "idiopathic incontinence" was established after endoscopy, endoanal ultrasound and measurement of pudendal nerve terminal motor latency underwent combined sphincter training for 3 months. The results were evaluated prospectively by clinical classification using a modified Kelly-Holschneider-score and anal manometry before and after treatment. Combined biofeedback led to a significant increase of the continence score in 18 of 22 patients (7.7 +/- 3.8 vs. 9.3 +/- 3.0, p = 0.004). Both squeeze (77 +/- 28 mmHg vs. 92 +/- 32 mmHg, p = 0.047) and resting pressures (40 +/- 19 vs. 52 +/- 23 mmHg, p = 0.015) increased significantly during the training period. There were no significant differences in squeeze and resting asymmetry indexes, sensory and urge thresholds and maximal tolerable volumes. The prolongation of biofeedback training from 3 to 6 months in 9 patients did not change clinical or manometric results significantly. The combination of biofeedback training with anal electrostimulation increases anal squeeze and resting pressures, thus leading to an improvement of clinical incontinence symptoms. Therefore it should be the first choice in the therapy of idiopathic fecal incontinence. A training period of 3 months seems to be sufficient.