Introduction Biofeedback therapy is known to be effective in Faecal Incontinence (FI) with reported success rates of around 70%. However, virtually all available data is from tertiary centres. We aimed to evaluate our biofeedback programme based on the Iowa protocol1within the constraints of a District General Hospital (DGH) and determine predictive factors for successful outcomes.
Method We retrospectively reviewed 199 FI patients (mean age 62 ± 1 years, 72% female) enrolled in our Gastroenterologist-led biofeedback programme between 2009–2014. Baseline symptoms, QOL scores, co-morbidities and investigations including lower GI endoscopy (91%) were noted in addition to anorectal manometry findings. Anorectal sphincter technique was graded (good, fair or poor) at each session. Based on symptoms during the last session, patients were classified as responders (complete or partial) or non-responders. The 2 groups were compared statistically for factors including; demographics, symptoms, pelvic dyssynergia, manometry data, sphincter exercises technique/practice and the number and frequency of biofeedback sessions. Data are expressed as the mean (± SEM) unless stated otherwise. P values ≤0.05 were deemed statistically significant.
Results All 199 patients had auditable outcome measures despite 5% having ongoing therapy and 23% drop out. Patients attended a mean 4 (± 0.1) biofeedback sessions with an interval of 69 (±3) days between visits. Neurotrac stimulator was used adjunctively in 12% of cases. Overall, 148/199 (74%) responded (complete n = 100, partial n = 48) with marked reduction in FI frequency (median before 7/week vs. post-treatment 0.25/week, U = 20,425, P < 0.0001). Whilst male gender was associated with poorer outcome (Chi2= 5.4, P = 0.02), documented ‘good’ sphincter exercise technique (Chi2= 9.3, P = 0.002) and longer weekly durations of sphincter exercises at home (df = 66.3, P = 0.01) were associated with favourable outcomes. By contrast, age, symptoms, QOL, physical/sexual abuse, depression, lateral sphincterotomy, resting and squeeze pressures, rectal sensitivity, dyssynergia, number and frequency of biofeedback sessions were not associated with outcomes.
Conclusion To the best of our knowledge this is the largest series from a DGH in the UK. Despite less intensive follow-up schedules we were able to achieve comparable outcomes to studies reported elsewhere with bi-weekly induction followed by periodic reinforcements suggesting our physician-led approach may be just as effective. Our data reinforces the importance of sphincter exercise technique, training and patient self-practice at home, which along with female gender appear to be predictive factors in successful outcomes.
Disclosure of interest None Declared.
Ozturk, et al .APT2004;20(6):667–74
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