Biofeedback therapy for fecal incontinence

Operant conditioning offers a new therapeutic modality for fecal incontinence. Our experience with biofeedback therapy in six male and six female patients (ages 12-78 years) is presented. Incontinence was associated with a surgical procedure in six patients and with a medical condition in six patients. Rectosphincteric manometry was performed using a three balloon technic, with one balloon positioned in the rectum as a distending stimulus and the others at the internal and external sphinchters. Pressure responses to measured volumes of rectal distention were displayed on a polygraph. Rectosphincteric reflexes and sensory thresholds for rectal distention were determined. Patients were then encouraged to elevate sphinchter pressures while observing their manometric responses. Follow-up of 10-96 weeks showed ten patients had good responses, with complete continence in six patients. Nine of 10 responders required only one treatment session. Operant conditioning is a valuable technic in properly selected patients with an 80% probability of success.