Electrical Stimulation and Pelvic Floor Muscle Training With Biofeedback in Patients With Fecal Incontinence: A Cohort Study of 281 Patients |
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| Authors: | M P Terra MD PhD A C Dobben MSc B Berghmans PhD M Deutekom PhD C G M I Baeten MD PhD L W M Janssen MD PhD G E E Boeckxstaens MD PhD A F Engel MD PhD R J F Felt-Bersma MD PhD J F M Slors MD PhD M F Gerhards MD PhD A B Bijnen MD PhD E Everhardt MD PhD W R Schouten MD PhD P M M Bossuyt PhD J Stoker MD PhD |
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| Institution: | (1) Department of Radiology, Academic Medical Center, G1-229, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;(2) Department of Urology, University Hospital Maastricht, Maastricht, The Netherlands;(3) Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands;(4) Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands;(5) Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands;(6) Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands;(7) Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands;(8) Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands;(9) Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands;(10) Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands;(11) Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands;(12) Department of Gynecology, Medical Spectrum Twente, Enschede, The Netherlands;(13) Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands |
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| Abstract: | Purpose Pelvic floor rehabilitation is an appealing treatment for patients with fecal incontinence but reported results vary. This
study was designed to assess the outcome of pelvic floor rehabilitation in a large series of consecutive patients with fecal
incontinence caused by different etiologies.
Methods A total of 281 patients (252 females) were included. Data about medical history, anal manometry, rectal capacity measurement,
and endoanal sonography were collected. Subgroups of patients were defined by anal sphincter complex integrity, and nature
and possible underlying causes of fecal incontinence. Subsequently patients were referred for pelvic floor rehabilitation,
comprising nine sessions of electric stimulation and pelvic floor muscle training with biofeedback. Pelvic floor rehabilitation
outcome was documented with Vaizey score, anal manometry, and rectal capacity measurement findings.
Results Vaizey score improved from baseline in 143 of 239 patients (60 percent), remained unchanged in 56 patients (23 percent), and
deteriorated in 40 patients (17 percent). Mean Vaizey score reduced with 3.2 points (P < 0.001). A Vaizey score reduction of ≥ 50 percent was observed in 32 patients (13 percent). Mean squeeze pressure (+5.1 mmHg;
P = 0.04) and maximal tolerated volume (+11 ml; P = 0.01) improved from baseline. Resting pressure (P = 0.22), sensory threshold (P = 0.52), and urge sensation (P = 0.06) remained unchanged. Subgroup analyses did not show substantial differences in effects of pelvic floor rehabilitation
between subgroups.
Conclusions Pelvic floor rehabilitation leads overall to a modest improvement in severity of fecal incontinence, squeeze pressure, and
maximal tolerated volume. Only in a few patients, a substantial improvement of the baseline Vaizey score was observed. Further
studies are needed to identify patients who most likely will benefit from pelvic floor rehabilitation.
Supported by grant 945-01-013 of the Netherlands Organization for Health Research and Development.
Presented at the United European Gastroenterology Week, Copenhagen, Denmark, October 15 to October 19, 2005.
Reprints are not available. |
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| Keywords: | Fecal incontinence Biofeedback Electrical stimulation therapy Pelvic floor Manometry |
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