Six patients with severe fecal incontinence and manometric evidence of external-sphincter impairment were taught to produce external-sphincter contraction in synchrony with internal-sphincter relaxation. These responses were induced by rectal distention. During follow-up periods ranging from six months to five years, four of the patients remained completely continent, and the other two were definitely improved. One patient who was trained to relax her internal sphincter as well as to contract her external sphincter not only was continent but also regularly had normal bowel movements, which she had not had before. The training technic was relatively simple to apply, and learning occurred within four sessions or less. The findings highlight the Importance of synchronized rectosphincteric responses in the maintenance of fecal continence, and they show that these responses can be brought under voluntary control in patients with chronic fecal Incontinence, even when the incontinence is secondary to organic lesions. (N Engl J Med 290:646–649, 1974). RECENT research has shown that a number of physiologic functions that are known to be auto-regulated can also be brought under voluntary control with use of the technics of operant conditioning.1 2 3 The degree of voluntary control that can be learned is sufficient to produce clinically important effects.4 Patients with atrial fibrillation can learn to control their ventricular rates,5 those with premature ventricular beats can learn to control the prevalence of this arrhythmia,6 and a patient with intermittent Wolff-Parkinson-White disease was able to learn independent control of cardiac rate and cardiac conduction.7 Patients with essential hypertension were able to lower their.
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