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Evidence summaries

Biofeedback and/or Sphincter Exercises for the Treatment of Faecal Incontinence in Adults

In the management of people with faecal incontinence, biofeedback and electrical stimulation may enhance the outcome of treatment compared to electrical stimulation alone or sphincter exercises alone. Level of evidence: "C"

The quality of evidence is downgraded by imprecise results (few patients and outcome events) and by study limitations (lack of allocation concealment).

Summary

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).

Clinical comments

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    References

    • Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 2012;7:CD002111. [PubMed]

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