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Can manometric parameters predict response to biofeedback therapy in fecal incontinence?
Y P Sangwan1, J A Coller, R C Barrett
1Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts 01805, USA.
Diseases of the Colon and Rectum
|October 1, 1995
Summary
Biofeedback therapy shows variable success for fecal incontinence. Pre-therapy manometry, except for high-pressure zone asymmetry, does not reliably predict patient response to treatment.
Area of Science:
- Gastroenterology
- Pelvic Floor Rehabilitation
- Anal Sphincter Function
Background:
- Fecal incontinence affects a significant portion of the population, impacting quality of life.
- Biofeedback therapy is a common treatment modality for fecal incontinence, aiming to improve fecal control.
- Predicting treatment success through pre-therapy assessments is crucial for patient selection and optimizing outcomes.
Purpose of the Study:
- To investigate whether pre-biofeedback manometric parameters can predict the success of biofeedback therapy in patients with fecal incontinence.
- To identify specific manometric indicators that may help select patients who are most likely to benefit from biofeedback.
Main Methods:
- A study involving 28 patients with fecal incontinence (idiopathic, iatrogenic, or obstetric trauma) undergoing biofeedback therapy.
- Biofeedback was administered using computer software to strengthen the external anal sphincter.
- Pre-therapy manometric parameters were analyzed to identify differences between responders and non-responders.
Main Results:
- Overall, 46.4% achieved excellent results, 28.6% had good results, and 24.5% did not improve.
- Pre-therapy resting or squeeze anal canal pressure, pressure volume, sphincter length, fatigue rate, and overall cross-sectional asymmetry did not significantly predict outcomes.
- Increased cross-sectional asymmetry of the high-pressure zone within the sphincter at rest and during squeeze was greater in non-responders (P < 0.07 and P < 0.04, respectively).
Conclusions:
- Pre-biofeedback manometric parameters, with the exception of high-pressure zone asymmetry, do not reliably predict response to biofeedback therapy for fecal incontinence.
- Increased cross-sectional asymmetry in the high-pressure zone may indicate a poorer outcome.
- Improvements in fecal continence after biofeedback may not be solely dependent on achieved resting and squeeze pressures.