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Published in: Diseases of the Colon & Rectum 12/2007

01-12-2007 | Original Contributions

Biofeedback vs. Electrostimulation in the Treatment of Postdelivery Anal Incontinence: A Randomized, Clinical Trial

Authors: Nazir Naimy, M.D., Anita Thomassen Lindam, R.N., Arne Bakka, M.D., Ph.D., Arne Engebritsen Færden, M.D., Pål Wiik, M.D., Ph.D., Erik Carlsen, M.D., Ph.D., Britt-Ingjerd Nesheim, M.D., Ph.D.

Published in: Diseases of the Colon & Rectum | Issue 12/2007

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Abstract

Purpose

This study was designed to evaluate the effect of biofeedback and electrostimulation in a randomized, clinical trial for the treatment of patients with postdelivery anal incontinence.

Methods

Forty-nine females who sustained third-degree or fourth-degree perineal rupture with a mean age of 36 (range, 22–44) years were included in the study. The females were randomized to biofeedback or electrostimulation treatment. Forty females completed the study: 19 in the biofeedback and 21 in the electrostimulation group. Biofeedback or electrostimulation sessions were performed two times daily for eight weeks in each group. Wexner incontinence score, fecal incontinence quality of life scores, and reduced quality of life on visual analog scale were registred before and after treatment. Patients’ self-rating of treatment effect also was registered in both groups. The primary outcome measure was the Wexner incontinence score.

Results

There were no differences in treatment effect between groups. Comparing pretreatment status to posttreatment in each group showed no improvement in Wexner score, reduced quality of life, or any of the fecal incontinence quality of life scores. Patients’ self-rating of the treatment effect, however, showed a subjective improvement of symptoms both in the biofeedback and in the electrostimulation group (median, 7 vs. 5.)

Conclusions

This study shows that there was no difference in effect between biofeedback and electrostimulation. Neither biofeedback nor electrostimulation treatments improved Wexner incontinence score, reduced quality of life, or fecal incontinence quality of life scores. Both treatments resulted in improvement of patients’ subjective perception of incontinence control.
Literature
1.
go back to reference Norton C, Kamm MA. Anal sphincter biofeedback and pelvic floor exercise for faecal incontinence in adults-a systematic review. Aliment Pharmacol Ther 2001;15:1147–54PubMedCrossRef Norton C, Kamm MA. Anal sphincter biofeedback and pelvic floor exercise for faecal incontinence in adults-a systematic review. Aliment Pharmacol Ther 2001;15:1147–54PubMedCrossRef
2.
go back to reference Patankar SK, Ferara A, Levy JR, Larach SW, Williamson PR, Perozo SE. Biofeedback in colorectal practice. A multicenter, statewide, three-year experience. Dis Colon Rectum 1997;40:827–31.PubMedCrossRef Patankar SK, Ferara A, Levy JR, Larach SW, Williamson PR, Perozo SE. Biofeedback in colorectal practice. A multicenter, statewide, three-year experience. Dis Colon Rectum 1997;40:827–31.PubMedCrossRef
3.
go back to reference Solomon MJ, Pager CK, Rex J, Roberts R, Manning J. Randomized controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence. Dis Colon Rectum 2003;46:703–10.PubMedCrossRef Solomon MJ, Pager CK, Rex J, Roberts R, Manning J. Randomized controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence. Dis Colon Rectum 2003;46:703–10.PubMedCrossRef
4.
go back to reference Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for faecal incontinence. Gastroenterology 2003;125:1–15.CrossRef Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for faecal incontinence. Gastroenterology 2003;125:1–15.CrossRef
5.
go back to reference Keinle P, Weitz J, Koch M, Benner A, Herfarth C, Schmidt J. Biofeedback versus electro-stimulation in the treatment of anal sphincter insufficiency. Digestive disease and sciences 2003;48:1607–13.CrossRef Keinle P, Weitz J, Koch M, Benner A, Herfarth C, Schmidt J. Biofeedback versus electro-stimulation in the treatment of anal sphincter insufficiency. Digestive disease and sciences 2003;48:1607–13.CrossRef
6.
go back to reference Mahony RT, Malone PA, Physio JN, Behan M, O’Connell R, O’Herlihy C. Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of anal sphincter in the early treatment of postpartum fecal incontinence. Am J Obstet Gynecol 2004;191:885–90.PubMedCrossRef Mahony RT, Malone PA, Physio JN, Behan M, O’Connell R, O’Herlihy C. Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of anal sphincter in the early treatment of postpartum fecal incontinence. Am J Obstet Gynecol 2004;191:885–90.PubMedCrossRef
7.
go back to reference Norton C, Cody JD, Hosker G. Biofeedback and /or sphincter exercises for the treatment of faecal incontinence in adults (Cochrane review). In: Cochrane Library, Issue 3, 2006 Norton C, Cody JD, Hosker G. Biofeedback and /or sphincter exercises for the treatment of faecal incontinence in adults (Cochrane review). In: Cochrane Library, Issue 3, 2006
8.
go back to reference Appell RA. Electrical stimulation for the treatment of urinary incontinence. Urology 1998;51(2A):24–6PubMedCrossRef Appell RA. Electrical stimulation for the treatment of urinary incontinence. Urology 1998;51(2A):24–6PubMedCrossRef
9.
go back to reference Seigel SW, Richardson DA, Miller KL, et al. Pelvic floor electrical stimulation for the treatment of urge and mixed urinary incontinence in women. Urology 1997;50:934–40.CrossRef Seigel SW, Richardson DA, Miller KL, et al. Pelvic floor electrical stimulation for the treatment of urge and mixed urinary incontinence in women. Urology 1997;50:934–40.CrossRef
10.
go back to reference Hosker G, Norton C, Brazzelli M. Electrical stimulation for faecal incontinence in adults (Cochrane review). In Cochrane Library; issue 2, 2000 Hosker G, Norton C, Brazzelli M. Electrical stimulation for faecal incontinence in adults (Cochrane review). In Cochrane Library; issue 2, 2000
11.
go back to reference Osterberg A, Graf W, Eeg-Olofsson K, Hallden M, Pahlman L. Is electrostimulation of the pelvic floor an effective treatment for neurogenic faecal incontinence. Scand J Gastroenterl 1999;34:319–24.CrossRef Osterberg A, Graf W, Eeg-Olofsson K, Hallden M, Pahlman L. Is electrostimulation of the pelvic floor an effective treatment for neurogenic faecal incontinence. Scand J Gastroenterl 1999;34:319–24.CrossRef
12.
go back to reference Osterberg A, Eeg-Olofsson KE, Hallden M, Graf W. Randomized clinical trial comparing conservative and surgical treatment of neurogenic faecal incontinence. Br J Surg 2004;91:1131–7.PubMedCrossRef Osterberg A, Eeg-Olofsson KE, Hallden M, Graf W. Randomized clinical trial comparing conservative and surgical treatment of neurogenic faecal incontinence. Br J Surg 2004;91:1131–7.PubMedCrossRef
13.
go back to reference Nazir M, Stein R, Carlsen E, Jacobsen AF, Nesheim B-I. Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture is misleading: an observational cohort study. Dis Colon Rectum 2003;46:1245–50.PubMedCrossRef Nazir M, Stein R, Carlsen E, Jacobsen AF, Nesheim B-I. Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture is misleading: an observational cohort study. Dis Colon Rectum 2003;46:1245–50.PubMedCrossRef
14.
go back to reference Jorge JM, Wener SD, Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.PubMedCrossRef Jorge JM, Wener SD, Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.PubMedCrossRef
15.
go back to reference Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000;43:9–17.PubMedCrossRef Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000;43:9–17.PubMedCrossRef
16.
go back to reference Noether GE. Introduction to statistics. A fresh approach. Boston: Houhton Mittlin Company, 1971 Noether GE. Introduction to statistics. A fresh approach. Boston: Houhton Mittlin Company, 1971
17.
18.
go back to reference Sparkel B, Maurer S, Langer M, Diller R, Spiegel HU, Winde G. Value of electrotheraphy within the scope of conservative treatment of anorectal incontinence. Zentralblatt Fur Chirurgie 1998;123:224–9. Sparkel B, Maurer S, Langer M, Diller R, Spiegel HU, Winde G. Value of electrotheraphy within the scope of conservative treatment of anorectal incontinence. Zentralblatt Fur Chirurgie 1998;123:224–9.
19.
go back to reference Rieger N, Schloithe A, Saccone G, Wattchow D. A prospective study of anal sphincter injury due to childbirth. Scand J Gastroenterol 1998;33:950–5.PubMedCrossRef Rieger N, Schloithe A, Saccone G, Wattchow D. A prospective study of anal sphincter injury due to childbirth. Scand J Gastroenterol 1998;33:950–5.PubMedCrossRef
20.
go back to reference Norton C, Gibbs A, Kamm MA. Randomized controlled trial of anal electrical stimulation for faecal incontinence. Dis Colon Rectum 2006;49:190–6.PubMedCrossRef Norton C, Gibbs A, Kamm MA. Randomized controlled trial of anal electrical stimulation for faecal incontinence. Dis Colon Rectum 2006;49:190–6.PubMedCrossRef
Metadata
Title
Biofeedback vs. Electrostimulation in the Treatment of Postdelivery Anal Incontinence: A Randomized, Clinical Trial
Authors
Nazir Naimy, M.D.
Anita Thomassen Lindam, R.N.
Arne Bakka, M.D., Ph.D.
Arne Engebritsen Færden, M.D.
Pål Wiik, M.D., Ph.D.
Erik Carlsen, M.D., Ph.D.
Britt-Ingjerd Nesheim, M.D., Ph.D.
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 12/2007
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-007-9075-5

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