Top

International Journal of Colorectal Disease

Published in:

Open Access 01-11-2013 | Original Article

Electrical stimulation and biofeedback for the treatment of fecal incontinence: a systematic review

Authors: Reinhard Vonthein, Tankred Heimerl, Thilo Schwandner, Andreas Ziegler

Published in: International Journal of Colorectal Disease | Issue 11/2013

Abstract

Purpose

This systematic review determines the best known form of biofeedback (BF) and/or electrical stimulation (ES) for the treatment of fecal incontinence in adults and rates the quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation. Attention is given to type, strength, and application mode of the current for ES and to safety.

Methods

Methods followed the Cochrane Handbook. Randomized controlled trials were included. Studies were searched in The Cochrane Library, MEDLINE, and EMBASE (registration number (PROSPERO): CRD42011001334).

Results

BF and/or ES were studied in 13 randomized parallel-group trials. In 12 trials, at least one therapy group received BF alone and/or in combination with ES, while ES alone was evaluated in seven trials. Three (four) trials were rated as of high (moderate) quality. Average current strength was reported in three of seven studies investigating ES; only two studies reached the therapeutic window. No trial showed superiority of control, or of BF alone or of ES alone when compared with BF + ES. Superiority of BF + ES over any monotherapy was demonstrated in several trials. Amplitude-modulated medium-frequency (AM-MF) stimulation, also termed pre-modulated interferential stimulation, combined with BF was superior to both low-frequency ES and BF alone, and 50 % of the patients were continent after 6 months of treatment. Effects increased with treatment duration. Safety reporting was bad, and there are safety issues with some forms of low-frequency ES.

Conclusions

There is sufficient evidence for the efficacy of BF plus ES combined in treating fecal incontinence. AM-MF plus BF seems to be the most effective and safe treatment.

Key Messages

• The higher the quality of the randomized trial the more likely was a significant difference between treatment groups.

• Two times more patients became continent when biofeedback was used instead of a control, such as pelvic floor exercises.

• Two times more patients became continent when biofeedback plus electrical stimulation was used instead of biofeedback only.

• Low-frequency electrical stimulation can have adverse device effects, and this is in contrast to amplitude-modulated medium-frequency electrical stimulation.

• There is high quality evidence that amplitude-modulated medium-frequency electrical stimulation plus electromyography biofeedback is the best second-line treatment for fecal incontinence.

Available only for authorised users

Nelson R, Norton N, Cautley E, Furner S (1995) Community-based prevalence of anal incontinence. JAMA 274(7):559–561PubMedCrossRef

Perry S, Shaw C, McGrother C, Matthews RJ, Assassa RP, Dallosso H, Williams K, Brittain KR, Azam U, Clarke M, Jagger C, Mayne C, Castleden CM (2002) Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 50(4):480–484. doi:10.1136/gut.50.4.480 PubMedCrossRef

National Institute for Health and Clinical Excellence (2007) Faecal incontinence: the management of faecal incontinence in adults. Clinical Guideline CG49. http://www.nice.co.uk. Accessed 04 June 2011

Probst M, Pages H, Riemann JF, Eickhoff A, Raulf F, Kolbert G (2010) Fecal incontinence: part 4 of a series of articles on incontinence. Dtsch Arztebl Int 107(34–35):596–601. doi:10.3238/arztebl.2010.0596 PubMed

Telford KJ, Faulkner G, Hosker GL, Kiff ES, Hill J (2004) The strength duration test: a novel tool in the identification of occult neuropathy in women with pelvic floor dysfunction. Colorectal Dis 6(6):442–445. doi:10.1111/j.1463-1318.2004.00666.x PubMedCrossRef

Ohlsson BL (1988) Effects of some different pulse parameters on the perception of intravaginal and intra-anal electrical stimulation. Med Biol Eng Comput 26(5):503–508PubMedCrossRef

Suhel P, Kralj B, Plevnik S (1978) Advances in nonimplantable electrical stimualtors for correction of urinary incontinence. TIT J Life Sci 8(1–2):11–16PubMed

Plevnik S, Janez J (1979) Maximal electrical stimulation for urinary incontinence: report of 98 cases. Urology 14(6):638–645PubMedCrossRef

Bergmann S, Eriksen BC (1986) Anal electrostimulation in urinary incontinence. Technical description of a new device. Urol Int 41(6):411–417PubMedCrossRef

10.

Green RJ, Laycock J (1990) Objective methods for evaluation of interferential therapy in the treatment of incontinence. IEEE Trans Biomed Eng 37(6):615–623. doi:10.1109/10.55665 PubMedCrossRef

11.

Schwandner T, Hemmelmann C, Heimerl T, Kierer W, Kolbert G, Vonthein R, Weinel R, Hirschburger M, Ziegler A, Padberg W (2011) Triple-target treatment versus low-frequency electrostimulation for anal incontinence—a randomized controlled trial. Dtsch Arztebl Int 108(39):653–660. doi:10.3238/arztebl.2011.0653 PubMed

12.

Monk DN, Mills P, Jeacock J, Deakin M, Cowie A, Kiff ES (1998) Combining the strength-duration curve of the external anal sphincter with manometry for the assessment of faecal incontinence. Br J Surg 85(10):1389–1393. doi:10.1046/j.1365-2168.1998.00956.x PubMedCrossRef

13.

Ziegler A, Heimerl A, Krockenberger K, Hemmelmann C (2012) Utility of medical devices: approaches to planning and conducting clinical trials. Z Evid Fortbild Qual Gesundhwes 106(5):322–331. doi:10.1016/j.zefq.2012.05.003 PubMedCrossRef

14.

Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE (2009) Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum 52(10):1730–1737. doi:10.1007/DCR.0b013e3181b55455 PubMedCrossRef

15.

Pilkington SA (2010) The role of biofeedback in improving continence after anterior resection. Interventionale Studie, University of Southampton, School of Medicine

16.

Healy CF, Brannigan AE, Connolly EM, Eng M, O'Sullivan MJ, McNamara DA, Cusack C, Deasy JM (2006) The effects of low-frequency endo-anal electrical stimulation on faecal incontinence: a prospective study. Int J Colorectal Dis 21(8):802–806. doi:10.1007/s00384-006-0102-0 PubMedCrossRef

17.

Hosker G, Cody JD, Norton CC (2007) Electrical stimulation for faecal incontinence in adults. Cochrane Database Syst Rev (3): CD001310. doi:10.1002/14651858.CD001310.pub2

18.

Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA (2003) Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 125(5):1320–1329. doi:10.1016/j.gastro.2003.09.039 PubMedCrossRef

19.

Norton C, Cody JD (2012) Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 7, CD002111. doi:10.1002/14651858.CD002111.pub3 PubMed

20.

Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schünemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW Jr, Zaza S (2004) Grading quality of evidence and strength of recommendations. Bmj 328(7454):1490. doi:10.1136/bmj.328.7454.1490 PubMedCrossRef

21.

Higgins JPT, Green S, Cochrane Collaboration (2008) Cochrane Handbook for Systematic Reviews of Interventions. Wiley-Blackwell, ChichesterCrossRef

22.

Piepho HP, Williams ER, Madden LV (2012) The use of two-way linear mixed models in multitreatment meta-analysis. Biometrics 88(4):1269–1277. doi:10.1111/j.1541-0420.2012.01786.x CrossRef

23.

Braun J, Willis S (2004) Fecal incontinence. Chirurg 75(9):871–881. doi:10.1007/s00104-004-0923-8 PubMedCrossRef

24.

Coulter ID, Favreau JT, Hardy ML, Morton SC, Roth EA, Shekelle P (2002) Biofeedback interventions for gastrointestinal conditions: a systematic review. Altern Ther Health Med 8(3):76–83PubMed

25.

Enck P, Van der Voort IR, Klosterhalfen S (2009) Biofeedback therapy in fecal incontinence and constipation. Neurogastroenterol Motil 21(11):1133–1141. doi:10.1111/j.1365-2982.2009.01345.x PubMedCrossRef

26.

Geile D, Osterholzer G, Rosenberg R (2004) Diagnostics and conservative treatment of anal incontinence. Wien Med Wochenschr 154(3–4):76–83PubMedCrossRef

27.

Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP (2008) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 4:CD007471. doi:10.1002/14651858.CD007471 PubMed

28.

Heymen S, Jones KR, Ringel Y, Scarlett Y, Whitehead WE (2001) Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum 44(5):728–736. doi:10.1007/BF02234575 PubMedCrossRef

29.

Kroesen AJ, Buhr HJ (2003) Biofeedback in faecal incontinence. Chirurg 74(1):33–41. doi:10.1007/s00104-002-0567-5 PubMedCrossRef

30.

Norton C, Kamm MA (2001) Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults–a systematic review. Aliment Pharmacol Ther 15(8):1147–1154. doi:10.1046/j.1365-2036.2001.01039.x PubMedCrossRef

31.

Norton C (2004) Behavioral management of fecal incontinence in adults. Gastroenterology 126(1 Suppl 1):S64–S70. doi:10.1053/j.gastro.2003.10.058 PubMedCrossRef

32.

Norton C (2008) Fecal incontinence and biofeedback therapy. Gastroenterol Clin North Am 37(3):587–604. doi:10.1016/j.gtc.2008.06.008, viiiPubMedCrossRef

33.

Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J (2010) Management of fecal incontinence in adults. Neurourol Urodyn 29(1):199–206. doi:10.1002/nau.20803 PubMedCrossRef

34.

Pares D, Norton C, Chelvanayagam S (2008) Fecal incontinence: the quality of reported randomized, controlled trials in the last ten years. Dis Colon Rectum 51(1):88–95. doi:10.1007/s10350-007-9146-7 PubMedCrossRef

35.

Wald A (2003) Biofeedback for fecal incontinence. Gastroenterology 125(5):1533–1535. doi:10.1016/j.gastro.2003.09.007 PubMedCrossRef

36.

Birkner B, Schepp W, Pehl C, Cluss B, Bittmann W, Emmert H, Fuchs M, Passern J, Wendl B, Heitland W (2000) Fecal incontinence. Diagnostic and therapeutic step scheme. Dtsch Arztebl 97(19):1302–1308

37.

Fernandez-Fraga X, Azpiroz F, Aparici A, Casaus M, Malagelada JR (2003) Predictors of response to biofeedback treatment in anal incontinence. Dis Colon Rectum 46(9):1218–1225. doi:10.1097/01.DCR.0000084337.15575.26 PubMedCrossRef

38.

Guillemot F, Bouche B, Gower-Rousseau C, Chartier M, Wolschies E, Lamblin MD, Harbonnier E, Cortot A (1995) Biofeedback for the treatment of fecal incontinence. Long-term clinical results. Dis Colon Rectum 38(4):393–397. doi:10.1007/BF02054228 PubMedCrossRef

39.

Kienle P, Weitz J, Koch M, Benner A, Herfarth C, Schmidt J (2003) Biofeedback versus electrostimulation in treatment of anal sphincter insufficiency. Dig Dis Sci 48(8):1607–1613. doi:10.1023/A:1024728210036 PubMedCrossRef

40.

Lacima G, Pera M, Amador A, Escaramis G, Piqué JM (2010) Long-term results of biofeedback treatment for faecal incontinence: a comparative study with untreated controls. Colorectal Dis 12(8):742–749. doi:10.1111/j.1463-1318.2009.01881.x PubMedCrossRef

41.

Loening-Baucke V (1990) Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function. Gut 31(12):1395–1402PubMedCrossRef

42.

Lorenz EP, Wondzinski A (1996) Results of conservative and surgical therapy of anal incontinence. 1974 to 1992 patient sample. Zentralbl Chir 121(8):669–675PubMed

43.

MacLeod JH (1987) Management of anal incontinence by biofeedback. Gastroenterology 93(2):291–294PubMed

44.

Menard C, Trudel C, Cloutier R (1997) Anal reeducation for postoperative fecal incontinence in congenital diseases of the rectum and anus. J Pediatr Surg 32(6):867–869PubMedCrossRef

45.

Musial F, Hinninghofen H, Frieling T, Enck P (2000) Therapy of fecal incontinence in elderly patients: Study of a home biofeedback training program. Z Gerontol Geriatr 33(6):447–453PubMedCrossRef

46.

Nicastro A, Stella LP, Nicolai AP (2006) Fecal incontinence: role of anal sphincter rehabilitation. Chir Ital 58(4):493–500PubMed

47.

Osterberg A, Graf W, Eeg-Olofsson K, Hallden M, Pahlman L (1999) Is electrostimulation of the pelvic floor an effective treatment for neurogenic faecal incontinence? Scand J Gastroenterol 34(3):319–324PubMedCrossRef

48.

Pager CK, Solomon MJ, Rex J, Roberts RA (2002) Long-term outcomes of pelvic floor exercise and biofeedback treatment for patients with fecal incontinence. Dis Colon Rectum 45(8):997–1003PubMedCrossRef

49.

Privitera AC, Oliveri CE, Randazzo G, Ohazuruike NL, Prumeri S, Politi A, Succi L (2009) Biofeedback therapy for faecal incontinence: our experience. Chir Ital 61(2):149–154PubMed

50.

Rieger NA, Wattchow DA, Sarre RG, Cooper SJ, Rich CA, Saccone GT, Schloithe AC, Toouli J, McCall JL (1997) Prospective trial of pelvic floor retraining in patients with fecal incontinence. Dis Colon Rectum 40(7):821–826. doi:10.1007/BF02055440 PubMedCrossRef

51.

Ryn AK, Morren GL, Hallbook O, Sjodahl R (2000) Long-term results of electromyographic biofeedback training for fecal incontinence. Dis Colon Rectum 43(9):1262–1266. doi:10.1007/BF02237433 PubMedCrossRef

52.

Shafik A, Ahmed I, El-Sibai O, Mostafa RM (2003) Percutaneous peripheral neuromodulation in the treatment of fecal incontinence. Eur Surg Res 35(2):103–107. doi:10.1159/000069399 PubMedCrossRef

53.

Solomon MJ, Rex J, Eyers AA, Stewart P, Roberts R (2000) Biofeedback for fecal incontinence using transanal ultrasonography: novel approach. Dis Colon Rectum 43(6):788–792. doi:10.1007/BF02238015 PubMedCrossRef

54.

Sprakel B, Maurer S, Langer M, Diller R, Spiegel HU, Winde G (1998) Value of electrotherapy within the scope of conservative treatment of anorectal incontinence. Zentralbl Chir 123(3):224–229PubMed

55.

Surh S, Kienle P, Stern J, Herfarth C (1998) Passive electrostimulation therapy of the anal sphincter is inferior to active biofeedback training. Langenbecks Arch Chir Suppl Kongressbd 115:976–978PubMed

56.

Terra MP, Dobben AC, Berghmans B, Deutekom M, Baeten CG, Janssen LW, Boeckxstaens GE, Engel AF, Felt-Bersma RJ, Slors JF, Gerhards MF, Bijnen AB, Everhardt E, Schouten WR, Bossuyt PM, Stoker J (2006) Electrical stimulation and pelvic floor muscle training with biofeedback in patients with fecal incontinence: a cohort study of 281 patients. Dis Colon Rectum 49(8):1149–1159. doi:10.1007/s10350-006-0569-3 PubMedCrossRef

57.

Uludag O, Darby M, Dejong CHC, Schouten WR, Baeten CGMI (2002) Sacral neuromodulation is effective in the treatment of fecal incontinence with intact sphincter muscles; a prospective study. Ned Tijdschr Geneeskd 146(21):989–993PubMed

58.

Whitehead WE, Burgio KL, Engel BT (1985) Biofeedback treatment of fecal incontinence in geriatric patients. J Am Geriatr Soc 33(5):320–324PubMed

59.

Willis S, Holzl F, Fackeldey V, Schumpelick V (2004) Effect of biofeedback and electrostimulation on sphincter function in fecal incontinence. Zentralbl Chir 129(3):211–215. doi:10.1055/s-2004-822743 PubMedCrossRef

60.

Ho Y-H, Bartlett L (2006) A randomized study to evaluate the effects of supplementary home biofeedback guided pelvic floor and anal squeeze exercises in the treatment of faecal incontinence to reduce bowel leakage and improve patient quality of life. Available via WHO ICTRP. www.anzctr.org.au/ACTRN12606000070538.aspx. Accessed Oct 2, 2012

61.

Leung FW (2011) Treatment of Patients With Fecal Incontinence. ClinicalTrials.gov. http://www.clinicaltrials.gov/show/NCT00292318. Accessed 02 Oct 2012

62.

Solomon M (2005) Randomized control trial of biofeedback guided pelvic floor exercises in the treatment in faecal incontinence. www.anzctr.org.au/ACTRN12605000747628.aspx. Accessed 02 Oct 2012

63.

Vonen B (2006) A randomized, controlled, clinical trial of biofeedback and anal injections as first treatment of fecal incontinence. Available via WHO ICTRP. http://clinicaltrials.gov/show/NCT00303030. Accessed 02 Oct 2012

64.

Jorge JM, Wexner SD, Morgado PJ Jr, James K, Nogueras JJ, Jagelman DG (1994) Optimization of sphincter function after the ileoanal reservoir procedure. A prospective, randomized trial. Dis Colon Rectum 37(5):419–423. doi:10.1007/BF02076184 PubMedCrossRef

65.

Latimer PR, Campbell D, Kasperski J (1984) A components analysis of biofeedback in the treatment of fecal incontinence. Biofeedback Self Regul 9(3):311–324PubMedCrossRef

66.

Miner PB, Donnelly TC, Read NW (1990) Investigation of mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 35(10):1291–1298. doi:10.1007/BF01536422 PubMedCrossRef

67.

Bols E, Berghmans B, de Bie R, Govaert B, van Wunnik B, Heymans M, Hendriks E, Baeten C (2012) Rectal balloon training as add-on therapy to pelvic floor muscle training in adults with fecal incontinence: a randomized controlled trial. Neurourol Urodyn 31(1):132–138. doi:10.1002/nau.21218 PubMedCrossRef

68.

Caldarella MP, Serio M, Milano A, Balatsinou C, Laterza F, Neri M (2008) Randomized controlled trial of biofeedback, electrical stimulation, and biofeedback plus electrical stimulation in patients with severe fecal incontinence after colo-anal anastomosis. Gastroenterology 134(4, Supplement 1):A-283. doi:10.1016/S0016-5085(08)61314-1 CrossRef

69.

Schnelle JF, Leung FW, Rao SS, Beuscher L, Keeler E, Clift JW, Simmons S (2010) A controlled trial of an intervention to improve urinary and fecal incontinence and constipation. J Am Geriatr Soc 58(8):1504–1511. doi:10.1111/j.1532-5415.2010.02978.x PubMedCrossRef

70.

Naimy N, Lindam AT, Bakka A, Faerden AE, Wiik P, Carlsen E, Nesheim BI (2007) Biofeedback vs. electrostimulation in the treatment of postdelivery anal incontinence: a randomized, clinical trial. Dis Colon Rectum 50(12):2040–2046. doi:10.1007/s10350-007-9075-5 PubMedCrossRef

71.

Bartlett L, Sloots K, Nowak M, Ho YH (2011) Biofeedback for fecal incontinence: a randomized study comparing exercise regimens. Dis Colon Rectum 54(7):846–856. doi:10.1007/DCR.0b013e3182148fef PubMedCrossRef

72.

Schwandner T, König IR, Heimerl T, Kierer W, Roblick M, Bouchard R, Unglaube T, Holch P, Ziegler A, Kolbert G (2010) Triple target treatment (3T) is more effective than biofeedback alone for anal incontinence: the 3T-AI study. Dis Colon Rectum 53(7):1007–1016. doi:10.1007/DCR.0b013e3181db7738 PubMedCrossRef

73.

Fynes MM, Marshall K, Cassidy M, Behan M, Walsh D, O'Connell PR, O'Herlihy C (1999) A prospective, randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma. Dis Colon Rectum 42(6):753–758. doi:10.1007/BF02236930 PubMedCrossRef

74.

Mahony RT, Malone PA, Nalty J, Behan M, O'Connell PR, O'Herlihy C (2004) Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter in the early treatment of postpartum fecal incontinence. Am J Obstet Gynecol 191(3):885–890. doi:10.1016/j.ajog.2003.10.040 PubMedCrossRef

75.

Ilnyckyj A, Fachnie E, Tougas G (2005) A randomized-controlled trial comparing an educational intervention alone vs education and biofeedback in the management of faecal incontinence in women. Neurogastroenterol Motil 17(1):58–63. doi:10.1111/j.1365-2982.2004.00611.x PubMedCrossRef

76.

Heymen S, Pikarsky AJ, Weiss EG, Vickers D, Nogueras JJ, Wexner SD (2000) A prospective randomized trial comparing four biofeedback techniques for patients with faecal incontinence. Colorectal Dis 2(2):88–92. doi:10.1046/j.1463-1318.2000.0136a.x PubMedCrossRef

77.

Solomon MJ, Pager CK, Rex J, Roberts R, Manning J (2003) 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 46(6):703–710. doi:10.1007/s10350-004-6643-9 PubMedCrossRef

78.

Norton C, Gibbs A, Kamm MA (2005) Randomized, controlled trial of anal electrical stimulation for fecal incontinence. Dis Colon Rectum 49(2):190–196. doi:10.1007/s10350-005-0251-1 CrossRef

79.

Naimy N, Lindam AT, Bakka A, Faerden AE, Wiik P, Carlsen E, Nesheim B-I (2007) Biofeedback vs. electrostimulation in the treatment of postdelivery anal incontinence: a randomized, clinical trial. Dis Colon Rectum 50(12):2040–2046. doi:10.1007/s10350-007-9075-5 PubMedCrossRef

80.

Ziegler A, Schwandner T (2013) Triple target treatment (3T) vs. biofeedback. Dis Colon Rectum 56(3):e35–e36. doi:10.1097/DCR.0b013e31827d1283 PubMedCrossRef

81.

Norton C (2001) Biofeedback for faecal incontinence. Available via WHO ICTRP. http://www.controlled-trials.com/ISRCTN45147456. Accessed 2 May 2011

82.

Norton C (2001) Randomised controlled trial of anal electrical stimulation in adults with faecal incontinence. Available via WHO ICTRP. www.controlled-trials.com/ISRCTN92215924. Accessed 2 May 2011

83.

Whitehead WE (2005) Biofeedback for Fecal Incontinence. Available via WHO ICTRP. http://clinicaltrials.gov/show/NCT00124904. Accessed 2 May 2011

84.

Schwandner T (2009) Prospektive randomisierte Studie zur konservativen Therapie der analen Inkontinenz mit Drei-Ziele-Behandlung (3T) vs. niederfrequente Elektrostimulation (NFS). DRKS00000138. https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00000138.

85.

Schwandner T (2010) Prospective, randomized multicenter study to assess the outcome of conservative 3T treatment with EMG-biofeedback. NCT00525291. http://clinicaltrials.gov/show/NCT00525291. Accessed 2 May 2011

86.

Bartlett L, Ho C (2010) A randomised clinical study was designed to compare two exercise regimen and determine the effect of an information session on the subjective rating of the symptoms of faecal incontinence and quality of life. ACTRN12610000258055. www.anzctr.org.au/ACTRN12610000258055.aspx. Accessed 20 Nov 2011

87.

Weimann D (2011) Triple target treatment. Coloproctology 33:252–254. doi:10.1007/s00053-011-0204-1 CrossRef

88.

Norton C (2010) Triple target treatment versus biofeedback. Dis Colon Rectum 53(7):971–972. doi:10.1007/DCR.0b013e3181ddc2f0 PubMedCrossRef

89.

Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43(1):9–16. doi:10.1007/BF02237236, discussion 16–17PubMedCrossRef

90.

Schwandner T, Hemmelmann C, Heimerl T, Kierer W, Kolbert G, Vonthein R, Weinel R, Hirschburger M, Ziegler A, Padberg W (2011) Triple-target treatment versus low-frequency electrostimulation for anal incontinence. Dtsch Arztebl Int 108(39):653–660. doi:10.3238/arztebl.2011.0653 PubMed

Title: Electrical stimulation and biofeedback for the treatment of fecal incontinence: a systematic review
Authors: Reinhard Vonthein
Tankred Heimerl
Thilo Schwandner
Andreas Ziegler
Publication date: 01-11-2013
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 11/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-013-1739-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Electrical stimulation and biofeedback for the treatment of fecal incontinence: a systematic review

Abstract

Purpose

Methods

Results

Conclusions

Key Messages

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Key Messages

Please log in to get access to this content

Other articles of this Issue 11/2013

The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients

Appraisal of the LIFT and BIOLIFT procedure: initial experience and short-term outcomes of 33 consecutive patients

A randomized crossover open trial of the adenoma miss rate for narrow band imaging (NBI) versus flexible spectral imaging color enhancement (FICE)

Expression and localization of axin 2 in colorectal carcinoma and its clinical implication

Overexpression of Lgr5 correlates with resistance to 5-FU-based chemotherapy in colorectal cancer

A new colorectal/coloanal anastomotic technique in sphincter-preserving operation for lower rectal carcinoma using transanal pull-through combined with single stapling technique