The results of pelvic muscle biofeedback exercise in children with faecal incontinence after surgery for severe anorectal malformation

Abstract

Purpose: Children with severe anorectal malformation, after anorectoplasty, frequently have faecal soiling, which is disruptive functionally and psychosocially. Post‐operative bowel management program involves multimodality treatment including drug manipulation, laxative enema and pelvic muscle training. The results of pelvic muscle biofeedback exercise are reviewed.Methods: Patients with anorectal malformation after anorectoplasty were followed‐up at continence clinic with symptom scoring (Rintala score). Co‐operative patients with problematic soiling were selected for biofeedback treatment program. Pelvic musculature anatomy and physiology were assessed by anorectal manometry, magnetic‐ resonance imaging and transrectal ultrasonography. They received active pelvic musculature stimulation and biofeedback training of pelvic muscle (Myoexorciser 1000 Biofeedback System – VERIMED, Florida, USA). Duration of treatment ranged from 3 to 6 months. Outcome was measured by incontinence score, manometry and electromyogram of pelvic muscle.Results: Eight boys, aged 5–11 years, completed the biofeedback program. Soiling frequency dropped significantly post treatment (P=0.0431). Electromyogram of pelvic muscle improved (P < 0.05). Overall symptom‐score confirmed functional improvement.Conclusions: Biofeedback training program benefits children with intractable soiling after surgery for severe anorectal malformation. Follow up studies are required to confirm whether the benefit is sustained in the long term.