Long-term outcome of anorectal biofeedback for treatment of fecal incontinence

Mazor Y1,2, Ejova A3, Andrews A1, Jones M3, Kellow J1,2, Malcolm A1,2. Neurogastroenterol Motil. 2018 Jun 1:e13389. doi: 10.1111/nmo.13389. [Epub ahead of print]

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1 Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonard's, NSW, Australia.

2 University of Sydney, Sydney, NSW, Australia.

3 Department of Psychology, Macquarie University, NSW, Australia.


BACKGROUND: Long-term outcome data for anorectal biofeedback (BF) for fecal incontinence (FI) is scarce. Our aims were to describe the long-term symptom profile, quality of life, and need for surgery in FI patients following BF.

METHODS: One hundred and eight consecutive female patients with FI who completed an instrumented BF course were identified for long-term follow-up. In 61 of 89 contactable patients, outcome measures were assessed at short-term (end of BF), mid-term (9 months median), and long-term (7 years median) follow-up after treatment.

KEY RESULTS: Long-term response rate (50% or more reduction in FI episodes/wk compared to before BF and not requiring surgical intervention) was seen in 33/61 (54%) patients. Thirteen of these had complete continence. Improvement was seen at short, mid, and long-term follow-up for patients' satisfaction and control of bowel function. In contrast, fecal incontinence severity index and quality of life measures, which improved in short and mid-term, were no different from baseline by long-term follow-up. Patients classified as short-term responders were far more likely to display a long-term response compared to short-term non-responders (68% vs 18%, P < .001).

CONCLUSIONS & INFERENCES: Long-term symptom improvement was observed in more than half of FI patients at 7 year post BF follow-up. Quality of life improvements, however, were not maintained. Patients improving during the initial BF program have a high chance of long-term improvement, while patients who do not respond to BF should be considered early for other therapies.

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