Keck J.O., Staniunas R.J. Biofeedback Training is Useful in Fecal Incontinence but Disappointing in Constipation

Biofeedback training is useful in fecal incontinence but
disappointing in constipation. Dis Colon Rectum 1994;37:
1271-1276.BACKGROUND: Successful biofeedback therapy has been
reported in the treatment of fecal incontinence and constipation.
It is uncertain which groups of incontinent patients
benefit from biofeedback, and our impression has been that
biofeedback is more successful for incontinence than for
constipation. PURPOSE: This study was designed to review
the results of biofeedback therapy at the Lahey Clinic.
METHODS: Biofeedback was performed using an eightchannel,
water-perfused manometry system. Patients saw
anal canal pressures as a color bar graph on a computer
screen. Assessment after biofeedback was by manometl 3,
and by telephone interview with an independent researcher.
RESULTS: Fifteen patients (13 women and 2 men)
with incontinence underwent a mean of three (range, 1-7)
biofeedback sessions. The cause was obstetric (four patients),
postsurgical (five patients), and idiopathic (six patients).
Complete resolution of symptoms was reported in
four patients, considerable improvement in four patients,
and some improvement in three patients. Manometry
showed a mean increase of 15.3 (range, -3-30) mmHg in
resting pressure and 35.7 (range, 13-57) mmHg in squeezing
pressure after biofeedback. A successful outcome could
not be predicted on the basis of cause, severity of incontinence,
or initial manometry. Twelve patients (10 women
and 2 men) with constipation underwent a mean of three
(range, 1-14) biofeedback sessions. Each had manometric
evidence of paradoxic nonrelaxing external sphincter or
puborectatis muscle confn'med by defography or electromyography.
All patients could be taught to relax their
sphincter in response to bearing down. Despite this, only
one patient reported resolution of symptoms, thrce patients
had reduced straining, and three patients had some gain in
insight. CONCLUSIONS: Biofeedback helped 73 percent of
patients with fecal incontinence, and its use should be
considered regardless of the cause or severity of incontinence
or of results on initial manometry. In contrast,
biofeedback directed at correcting paradoxic external
sphincter contraction has been disappointing. [Key words:
Biofeedback; Fecal incontinence; Nonrelaxing puborectalis;
Constipation; Manometry]