The quality of evidence is downgraded by imprecise results (few patients and outcome events) and by study limitations (lack of allocation concealment).
A Cochrane review [Abstract] 1 included 21 studies with a total of 1525 participants to evaluate the effects of biofeedback and/or anal sphincter exercises/pelvic floor muscle training for the treatment of faecal incontinence in adults.
Methods studied were anal sphincter exercises and/or biofeedback and sacral nerve stimulation. The term 'anal sphincter exercises' included: anal sphincter muscle exercises, 'Kegel exercises' pelvic floor exercises, or pelvic floor muscle training. All types of visual, sensory (usually with a rectal balloon) or auditory biofeedback were considered. The specific techniques used for biofeedback differed among studies.
One trial (n=108) showed that biofeedback plus exercises was better than exercises alone (RR for failing to achieve full continence 0.70, 95% CI 0.52 to 0.94). Another trial (n=80) showed that adding biofeedback to electrical stimulation was better than electrical stimulation alone (RR for failing to achieve full continence 0.47, 95% CI 0.33 to 0.65).
The combined data of two trials (n=167) showed that the number of people failing to achieve full continence was significantly lower when electrical stimulation was added to biofeedback compared against biofeedback alone (RR 0.60, 95% CI 0.46 to 0.78).
Sacral nerve stimulation was better than conservative management which included biofeedback and PFMT (at 12 months the incontinence episodes were significantly fewer with sacral nerve stimulation (MD 6.30, 95% CI 2.26 to 10.34, 1 trial, n=120).
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