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Biofeedback re-education of faecal continence in children
P Arhan1, C Faverdin, G Devroede
1Département de chirurgie pédiatrique, Hôpital des Enfants Malades, Paris, France.
Insights
Pretreatment anorectal motility in children does not predict successful biofeedback therapy for fecal incontinence. This finding impacts treatment strategies for pediatric fecal incontinence.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Rehabilitation Medicine
Background:
- Fecal incontinence in children can stem from various conditions, including constipation, anorectal malformations, and pelvic abnormalities.
- Biofeedback therapy is a common treatment for pediatric fecal incontinence, aiming to improve sphincter control.
Purpose of the Study:
- To investigate whether pretreatment anorectal motility parameters can predict the success of biofeedback therapy in children with fecal incontinence.
- To evaluate the efficacy of biofeedback in a diverse pediatric population with fecal incontinence.
Main Methods:
- Prospective study of 47 children (aged 5-18) with fecal incontinence.
- Anorectal manometry performed at the first session to measure resting pressures, sensory thresholds, and voluntary contraction.
- Biofeedback therapy administered, with success defined as full continence restoration.
Main Results:
- The study did not find a correlation between pretreatment anorectal motility measurements and the success of biofeedback therapy.
- Children with idiopathic constipation, anorectal malformations, and congenital pelvic abnormalities showed variable responses to biofeedback.
Conclusions:
- Pretreatment anorectal manometry is not a reliable predictor of biofeedback success in pediatric fecal incontinence.
- Further research is needed to identify predictors of successful biofeedback therapy for fecal incontinence in children.
Abstract:
The purpose of this prospective study was to see if pretreatment anorectal motility can predict successful correction of faecal incontinence with biofeedback. Forty-seven consecutive children, aged 5 to 18 years, were treated. They had been treated for idiopathic constipation with faecal impaction, but had remained incontinent (n = 15), had been operated for congenital anorectal malformations of high (n = 19) or low (n = 2) type, or had a number of organic congenital pelvic abnormalities (n = 11). This consecutive series represents our entire experience with biofeedback for faecal incontinence, in the period from January 1 1983 to December 31 1989. In each patient, at the first session, anorectal manometry was performed. Resting pressures in the rectum, upper anal canal and lower anal canal were measured. The threshold of rectal sensation during distension, the maximal pressure during voluntary sphincteric contraction and the time to half decrease of sphincteric pressure because of muscular fatigue were also noted. The patient was then asked to make a voluntary sphincteric contraction, while the rectum was being distended with the volume at threshold for rectal sensation. In subsequent sessions, the rectum was also distended but without warning the patient, who was congratulated when he or she contracted the sphincter immediately after onset of rectal distension. Full continence was the criterion used to classify re-education as a success. Improvement or no change in continence was considered as failure of the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)