[Faecal incontinence: physiotherapy first before referral for further diagnostics and therapy]

The predictive value of diagnostic tests for faecal incontinence with respect to the outcome of physiotherapy was investigated in a recent study. No obvious predictors were found. This is not surprising. Diagnostic tests are known to exhibit a large overlap with healthy controls. Further, the study was carried out in 15 hospitals, each of which had its own method for performing these tests. Physiotherapy according to a treatment protocol was given by 48 physiotherapists. The Vaizey score was used as the outcome measure and revealed an improvement of 50% or more in 13% of patients. However, some clinical changes important for the patient are missed by this score. The rate of effectiveness for physiotherapy reported in literature is around 70%. This study not only shows that diagnostic tests have little predictive value regarding the outcome of physiotherapy, but, more importantly, that all patients with faecal incontinence should have physiotherapy first. Patients who do not improve should be referred to a specialist for further diagnostics and therapy.