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Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fecal incontinence in women - a randomized controlled trial
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
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2015 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, no 8, 965-974 p.Article in journal (Refereed) Published
Abstract [en]

Objective. Biofeedback and medical treatments have been extensively used for moderate fecal incontinence (FI). There is limited data comparing and combining these two treatments. The objective of this study was to evaluate the effect of biofeedback and medical treatments, separately and in combination. Material and methods. Sixty-four consecutive female patients, referred to a tertiary centre for FI, were included. The patients were randomized to start with either biofeedback (4-6 months) or medical treatment with loperamide and stool-bulking agents (2 months). Both groups continued with a combination of treatments, i.e. medical treatment was added to biofeedback and vice versa. A two-week prospective bowel symptom diary and anorectal physiology were evaluated at baseline, after single-and combination treatments. Results. Fifty-seven patients completed the study. Median number of leakage episodes during two weeks decreased from 6 to 3 (p less than 0.0001) from baseline to completion. The patients showed a significant (1) decrease in number of leakages without forewarning (p = 0.04); (2) decrease in number of stools with urgency (p = 0.001); (3) decrease in number of loose stool consistency; and (4) an increase in rectal sensory thresholds, both for maximum tolerable rectal pressure and first sensation (less than 0.01). The combination treatment was superior to both single treatments in terms of symptoms and functions. There was no significant difference between the two groups at any time point. Conclusions. The combination therapy with biofeedback and medical treatment is effective for symptom relief in FI. The symptom improvement was associated with improved fecal consistency, reduced urgency, and increased rectal sensory thresholds.

Place, publisher, year, edition, pages
TAYLOR and FRANCIS LTD , 2015. Vol. 50, no 8, 965-974 p.
Keyword [en]
anorectal manometry; biofeedback; incontinence; pelvic floor exercises
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:liu:diva-121926DOI: 10.3109/00365521.2014.999252ISI: 000361323200005PubMedID: 25892434OAI: oai:DiVA.org:liu-121926DiVA: diva2:860717
Note

Funding Agencies|County Council of Ostergotland

Available from: 2015-10-13 Created: 2015-10-12 Last updated: 2017-12-01

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Sjödahl, JennyWalter, SusannaHallböök, Olof

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Division of PhysiotherapyFaculty of Medicine and Health SciencesDivision of Neuro and Inflammation ScienceDepartment of GastroentorologyDivision of Clinical SciencesDepartment of Surgery in Linköping
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