Fecal Incontinence In Patients Research Articles

Biofeedback Treatment of Fecal Incontinence in Patients with Myelomeningocele

Biofeedback Treatment of Fecal Incontinence in Patients with Myelomeningocele

Use of Biofeedback in Treatment of Fecal Incontinence in Patients with Meningomyelocele

Fourteen children (aged 5 to 17 years) with meningomyelocele and significant fecal soiling underwent anorectal manometry using a three-balloon system connected to a physiograph. On the basis of manometric criteria demonstrating some rectal sensation, eight patients were treated with biofeedback conditioning. Patients were taught to contract the external and sphincter or nearby gluteal muscles in response to various volumes of rectal distention. Four of the eight patients who were treated with biofeedback had a good clinical response with disappearance of soiling or a greater than 75% improvement in the frequency of soiling. Follow-up periods ranged from three to 12 months. The minimum criteria for successful treatment appeared to be normal threshold of rectal sensation and ability to contract gluteal or related muscles. Anorectal manometry is a rapid, easily obtained test that can identify those children with meningomyelocele and fecal incontinence who may benefit from biofeedback conditioning. Biofeedback is a simple, safe, and effective technique in the treatment of certain children with fecal soiling due to neurogenic anal sphincter dysfunction.

Spina Bifida: A New Disease

The paper by Wald entitled "Biofeedback in the Treatment of Fecal Incontinence in Patients with Myelomeningocele" (Pediatrics 68:45, 1981) represents an additional small, but significant step in the management of children with spina bifida. In the 1950s most children with spina bifida were left to die. In the 1960s most were vigorously treated. In the early 1970s Dr John Lorber presented a retrospective analysis of his results, and published his criteria for selection.1 Over these three decades the approach to the newborn with spina bifida has swung like a pendulum. More recent series2,3 demonstrate that with early treatment more than 80% of children survive; in our experience more than 95% survive.

Biofeedback Treatment of Fecal Incontinence in Patients with Myelomeningocele

Approximately six hours of biofeedback training was given to eight fecally incontinent children with myelomeningocele in order to establish bowel control. Their ages ranged from five to 15 years. The patients were shown a polygraph tracing of the external anal sphincter while they were being encouraged voluntarily to contract the sphincter when the rectum was distended with progressively larger volumes of air in a balloon. Seven of the eight patients showed normal sensation for rectal distension. Following this training period, five of the children had no incontinent periods, and two of these had discontinued enemas or suppositories. A sixth patient had an 80 per cent reduction in the frequency of incontinence. The remaining two did not benefit. At follow-up between 13 and 24 months later, four children were incontinent once a month or less often; two others were incontinent once per day, a considerable decrease from the pretraining period. The two children who failed to learn were still incontinent at follow-up. These results show that fecally incontinent patients with myelomeningocele can learn to evacuate normally or to reduce soiling after a relatively short period of biofeedback training.

Fecal incontinence in chronic diarrhea

Abstract Patients with chronic diarrhea and fecal incontinence are unable to retain as much rectally infused saline as patients without incontinence. We explored the effect of training such a patient to retain rectally infused saline. The patient was a 31-yr-old female with chronic diarrhea of obscure etiology who had daily episodes of fecal incontinence which markedly restricted her lifestyle. Training was accomplished by urging the patient to retain as much of a 25-min rectal infusion of 1500 ml saline as possible. After 10 training sessions, the patient increased her ability to hold rectally infused saline almost sevenfold. This increase was well maintained over 10 wk. In spite of continued diarrhea, the patient's incontinence did not recur after the first week of training, and she was able to resume a normal life. Anal sphincter pressure and a test of continence for a solid sphere did not change during or after training. This simple training technique has potential as a treatment for disabling fecal incontinence in patients with chronic diarrhea.

Fecal incontinence in chronic diarrhea: Report of a case with improvement after training with rectally infused saline

Patients with chronic diarrhea and fecal incontinence are unable to retain as much rectally infused saline as patients without incontinence. We explored the effect of training such a patient to retain rectally infused saline. The patient was a 31-yr-old female with chronic diarrhea of obscure etiology who had daily episodes of fecal incontinence which markedly restricted her lifestyle. Training was accomplished by urging the patient to retain as much of a 25-min rectal infusion of 1500 ml saline as possible. After 10 training sessions, the patient increased her ability to hold rectally infused saline almost sevenfold. This increase was well maintained over 10 wk. In spite of continued diarrhea, the patient's incontinence did not recur after the first week of training, and she was able to resume a normal life. Anal sphincter pressure and a test of continence for a solid sphere did not change during or after training. This simple training technique has potential as a treatment for disabling fecal incontinence in patients with chronic diarrhea.

Pressure-length loop: a new method for simultaneous measurement of segmental and total cardiac function.

Pressure-length loop: a new method for simultaneous measurement of segmental and total cardiac function.