A randomized controlled trial of four different regimes of biofeedback programme in the treatment of faecal incontinence. (2nd April 2018)

• Record Type: Journal Article
• Authors: Young, C. J.; Zahid, A.; Koh, C. E.; Young, J. M.; Byrne, C. M.; Solomon, M. J.; Rex, J.; Candido, J.
• Is Part Of: Colorectal disease. Volume 20:Number 4(2018)
• Page Start: 312
• Page End: 320
• Publication Date: 2018-04-02
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.13932
• Languages: English
• ISSNs: 1462-8910

Abstract

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: This was a randomized control trial of patients with FI, stratified into two groups (metropolitan and rural) and then randomized 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 standardized counselling and education, dietary modification and the use of anti‐diarrhoeal medications. Group 1 received four 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 one‐off face‐to‐face biofeedback treatment. Primary outcomes were patient‐assessed severity of FI and quality of life as assessed by the 36‐item Short Form Health Survey 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 and 2012, 351 patients were recruited. One patient died leaving 350 for analysis. 332 (95%) were women. 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.