A Randomised Control Trial of Four Different Regimes of Biofeedback Program in the Treatment of Faecal Incontinence

Young CJ1,2, Zahid A1, Koh CE1,2,3, Young JM3,4, Byrne CM1,2, Solomon MJ1,2,3, Rex J5, Candido J5. Colorectal Dis. 2017 Oct 20. doi: 10.1111/codi.13932. [Epub ahead of print]
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1 Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 2 The University of Sydney, Discipline of Surgery, Sydney, New South Wales, Australia. 3 Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 4 University of Sydney, School of Public Health, Sydney, New South Wales, Australia. 5 Royal Prince Alfred Hospital, NSW Biofeedback and Continence Centre (BACC), Sydney, New South Wales, Australia. Abstract

AIM: Biofeedback is an established, effective and non-invasive treatment for faecal incontinence (FI). The aim was to compare the effectiveness of four different biofeedback treatment regimes.

METHOD: Randomised control trial of patients with FI, stratified into two groups (metropolitan and rural) and then randomised into two subgroups (groups 1 and 2 within metropolitan, groups 3 and 4 within rural) with varying face-to-face and telephone biofeedback components. All patients received standardised counselling and education, dietary modification and the use of anti-diarrhoeal medications. Group 1 received 4 monthly face-to-face biofeedback treatments, groups 2 and 3 received one face-to-face biofeedback followed by telephone biofeedback and group 4 received a once-off face-to-face biofeedback treatment. Primary outcomes were patient assessed severity of FI and quality of life as assessed by SF-36 and direct questioning of objectives. Secondary outcomes included St Mark's incontinence score, anxiety, depression and anorectal physiology measures (resting, squeeze pressures; isotonic, isometric fatigue times).

RESULTS: Between 2006-2012, 351 patients were recruited. One patient died leaving 350 for analysis. 332 (95%) were females. Mean age was 60 (SD = 14). All groups had significant improvements in FI, quality of life, incontinence score and mental status (p < 0.001 each). There were no differences in improvements in FI between groups although patient satisfaction was less with reduced face-to-face contact. There were modest improvements in isotonic and isometric fatigue times suggesting improved sphincter endurance (both p < 0.001).

CONCLUSION: Biofeedback is effective for FI. Although face-to-face and telephone biofeedback is not necessary to improve FI, it is important for patient satisfaction.

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