Biofeedbackin fecal incontinence.pdf

Pudendal Neuropathy and Severity of Incont inence but not Presence of an Anal Sphincter Defect May Determine the Response to Biofeedback Therapy in Fecal Incontinence Anne-Marie Leroi, M.D., Marie-Paule Dorival, Marie-Frangoise Lecouturier, Christine Salter, Marie-Laure Welter, M.D., Jean-Yves Touchais, M.D., Philippe Denis, Ph.D. From the Groupe de Recherche sur lAppareiI Digestil~, H6pital Charles Nicolle, Rouen, France PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improve- ment and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal net~opathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29-74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients befure biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeed- back sessions. RESULTS: Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no rela- tionship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neu- ropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neu- ropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biof