Combined biofeedback, physiotherapy and electrostimulation for fecal incontinence

Different outcomes are reported in the literature following pelvic floor rehabilitation for fecal incontinence, possibly due to the type of procedure employed, whether biofeedback or physiotherapy or electrostimulation. The aim of the present study is to analyze the results achieved in a group of patients treated with a combination of the three procedures. Thirty-two patients (24 females) affected by fecal incontinence underwent a course of combined rehabilitation (CR); 23 of them had anal surgery prior to CR, for rectal mucosal prolapse and hemorrhoids in most cases. Eighteen had anal manometry before and after CR. Sixteen underwent anal ultrasound prior to treatment. Patients were taught perineal exercises, biofeedback was either sensory or electromyographic, and electrostimulation was performed with a 10-20 MHz endoanal probe. Twenty-seven patients were available for follow-up. The mean incontinence score improved from 4.0 ± 0.8 to 2.1 ± 1.7 (mean±sd) (p<0.001); 19 patients (70%) were satisfied after CR, and 11 (44%) were fully continent. Post-treatment manometry showed an increased amplitude of squeeze pressure in 50% of the cases, whereas 61% had an increase in duration, but only 27% of them had a positive clinical outcome. Rectal evacuation thresholds improved in 55% of the cases and 86% of them had a corresponding positive clinical outcome. At ultrasound, 6 patients showed intact anal sphincters and had a positive outcome following CR. Pelvic floor rehabilitation seems to be effective for the management of fecal incontinence when carried out combining different types of procedures. No significant correlation was found between manometric and clinical response to the treatment. An increase of rectal sensation may be responsible for the clinical improvement.