Progress in Biofeedback Conditioning for Fecal Incontinence

Fifty consecutive patients with severe daily fecal incontinence for 1–38 yr were treated with biofeedback training using a 3-balloon system connected to a physiograph. Ages ranged from 6 to 97 yr (average 46 yr) including 36 females and 14 males. Follow-up period was 4–108 mo (average 32 mo, median 26 mo). Twenty-four patients had incontinence associated with previous anorectal surgery. Eleven patients had spinal surgery. Medical problems associated with incontinence included irritable bowel syndrome, diabetes, rectal prolopse, multiple sclerosis, scleroderma, and stroke. Patients were taught to develop reflex transient contraction of the external sphincter in response to rectal distention. Increasing sensitivity was conditioned by gradually decreasing the distending volume. Thirty-six of 50 patients achieved a good symptomatic response to biofeedback training as evidenced by disappearance of incontinence or by decrease in frequency of incontinence by 90%. Before conditioning, threshold (minimal volume of distention required to produce external sphincter contraction) was similar (40 cc) in both good responders and poor responders. Eight good responders, before conditioning, had no contraction to volumes of 50 cc or greater. After conditioning, threshold diminished to 16 cc in the responders and 33 cc in the poor response group. Seventy-five percent (27) of those who achieved a good response did so after one conditioning session. Only 2 patients regressed temporarily, and they responded to repeat conditioning. The patients with impaired sphincter muscle but normal neural apparatus had better results. There are no medical contraindications to the procedure. It is simple, rapid, and without morbidity. The effectiveness of this biofeedback conditioning demonstrates for the first time that manometric techniques can play a direct therapeutic role in the treatment of gastrointestinal disorders.