1. Biofeedback Therapy (BFT) is an Effective Treatment Strategy in Refractory Fecal Incontinence (FI)
Francis Okeke M.D., Ahmed Salem M.D., John O Clarke M.D., Sameer Dahalla M.D., Monica Nandwani C.R.N.P., Ellen Stein M.D., Bani C Roland M.D.
Background and Aims
Results
Table 2: Conservative Therapy Vs BFT
Fecal incontinence (FI) is a prevalent and socially devastating condition. Currently, there are few effective treatment strategies. Conservative therapy has modest benefit. Prior studies have suggested variable success rates of biofeedback therapy (BFT) in FI. Although BFT is a well-established treatment modality in dyssynergic defecation (DD), its efficacy in FI patients who have failed conservative therapy remains less clear. Our primary aims were to assess BFT treatment response among FI patients who have failed conservative therapies and evaluate clinical response rate to non-BFT therapies Assess risk factors predictive of BFT treatment. .failure.
A total of 513 completed ARM within the study period; 111 (22%) patients were referred for FI.
Of this subgroup, 25 were initially treated with conservative measures, but only 6 (24%) reported benefit, while 19 (76%) reported no benefit(p <0.0001). 46 (41%) patients were referred to BFT and of those 29 (63%) patients successfully underwent BFT. Of these 29, the majority reported benefit (n=22, 76% vs no benefit in 24%, p <0.0001). 4 who underwent BFT without benefit were referred for SNS (n=1), Solesta (n=1), or surgery (n=2).
Table 1: Treatment Options Used in The Study
Conclusions
Methods
We reviewed consecutive FI patients referred for high-resolution anorectal manometry at a single tertiary care center from 1/2012-7/2013. BFT was recommended for DD, weak augmentation of sphincter tone, low resting pressure, or impaired/heightened intrarectal sensation.
Conservative therapy included stool bulk forming agents and/or anti-diarrheals. Clinical treatment response was assessed after BFT (5 sessions) by at least 50% reduction in FI episode frequency/week.
The management of FI remains challenging with limited therapeutic options. Our results show the majority of FI patients who fail to improve with conservative measures can improve with BFT. The only predictors of BFT treatment failure were pelvic organ prolapse & neurologic disease. Our findings suggest that BFT is of significant benefit in FI patients who have failed conservative therapies & may be considered as a reasonable treatment strategy. Large-scale, prospective studies are needed to further delineate the efficacy of BFT & predictors of clinical response.