Biofeedback conditioning for fecal incontinence in anorectal malformations

Twenty children aged 6–18 years who had deficient fecal continence after primary and secondary surgery for anorectal malformations were treated by biofeedback conditioning. The original malformation was high in 17 cases and low in 3. Pretreatment manometric assessments and training were performed with a perfused open-tip catheter connected to a recording unit where the manometric tracings could be inspected digitally or from the pressure curve. A latex balloon was used to stimulate the rectum. The patients were taught to develop maximal sphincter contraction and synchronize the contraction with rectal distention. Rectal sensitivity was conditioned by gradually decreased balloon volumes. There were 4–11 training sessions. The follow-up time was 2–24 months. Sixteen of the 20 patients responded favorably to the training. Fecal continence and the ability to take part in a normal social life improved significantly in the responders. In the responders, the contractile power of the sphincter increased significantly while other manometric parameters (basal anal canal pressure, rectal sensitivity, rectal capacity, rectoanal inhibitory reflux) could not be influenced. Biofeedback is a safe, simple, and effective method in treating fecal incontinence associated with anorectal malformations.