Influence of sphincter defect on biofeedback outcomes in patients with fecal incontinence

• Main Author: Kaiser Junior,Roberto L.
• Publication Date: 2014
• Other Authors: Silva,Giovanna da, Braile,Domingo M., Wexner,Steven D.
• Format: Article
• Language: eng
• Source: Journal of Coloproctology (Rio de Janeiro. Online)
• Download full: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2237-93632014000200067
• topic: Fecal incontinence; Biofeedback; Sphincter defect; Endoanal ultrasound

OBJECTIVE: to evaluate the effect of sphincter defect (SD) on biofeedback (BF) response in patients with fecal incontinence. METHODS: two hundred and forty-two patients with fecal incontinence undergoing BF as exclusive treatment were identified from a BF database. Patients were evaluated with fecal incontinence score (Cleveland Clinic Florida - Fecal Incontinence Score, CCF-FI) and anorectal physiology tests. The pre- and immediate post-treatment outcomes were obtained from the chart, and the long-term outcomes by CCF-FI score that was sent by mail. RESULTS: 242 patients underwent BF for fecal incontinence. 143 (59.1%) underwent ultrasonography, 43 (30.1%) of whom had sphincter defect detected on US. The immediate outcomes were not affected by the presence of absence of SD. The second CCF-FI questionnaire was mailed after a mean of 6.1 years after treatment. 31 (57.4%) exhibited improvement, 4 (7.4%) remained unchanged, and 19 (35.2%) had worsening function, which was significantly inferior in patients with SD (p = 0.021). Electromyography demonstrated increased electrical activity in the contraction phase after BF in both groups. CONCLUSIONS: the majority of patients experience improvement in fecal incontinence after BF. However, patients with SD detected on US prior to treatment seem to have worse function at long term.