Hypothesis/Aims of Study
Fecal Incontinence is a common problem in children that affects the quality of life of both the children and their family as an unpleasant complication.This study investigated whether combining tecartherapy with biofeedback yields superior outcomes compared to biofeedback alone or standard medical care in treating pediatric fecal incontinence associated with chronic constipation[1]. We hypothesized that the multimodal physiotherapy approach would demonstrate significant improvements in symptom severity and incontinence frequency.

The present study was a single-blind randomized clinical trial. 
In this clinical trial, 81 children with fecal incontinence were randomized into three groups:
Standard medical care (control)
Combined tecartherapy+ biofeedback
Biofeedback alone

The participants  were randomly divided into three intervention groups . Control group: routine medical care including diet and lifestyle modification and laxative consumption Intervention group 1: biofeedback therapy , 2 sessions a week and Intervention group 2, biofeedback therapy along with tecar therapy ,2 sessions a week 
This study will have a 6-week intervention time .
Primary and secondary outcomes measured over six weeks included:
	The severity of incontinence based on the Rintala Pediatric Incontinence Questionnaire
	The severity of constipation according to the Pediatric Constipation Severity Index [2]. 
	The frequency of incontinence episodes per week

Both intervention groups showed statistically significant improvement versus controls (p<0.01, ANOVA). The tecartherapy-biofeedback combination demonstrated superior outcomes in incontinence severity reduction (mean difference -2.4 points, 95% CI -3.1 to -1.7) compared to biofeedback alone. Constipation symptoms improved comparably in both intervention groups.

The enhanced efficacy of combined tecartherapy [3] suggests synergistic effects on pelvic floor muscle recruitment and rectal sensitivity modulation. The non-invasive nature of both modalities supports their safety profile in pediatric populations.

Multimodal physiotherapy incorporating tecartherapy and biofeedback should be considered as first-line intervention for pediatric fecal incontinence with constipation. Clinical implementation should prioritize accessible tecartherapy protocols to maximize treatment outcomes.

Abdelrahman EM, Ghafar MAA, Selim AO, Ali OI, Sakr AE, Kharoub MS. Long-term effect of biofeedback training on functional nonretentive fecal incontinence in children: a randomized controlled study. The Egyptian Journal of Surgery.2022;41(2):807-14.
Ghaderi F, Jamshidi M, Sarbakhsh P, Kharaji G. Cross-cultural adaptation, validity, and reliability of the pediatric constipation score-parent report in pediatric functional constipation in an Iranian population. Gastroenterology and Hepatology From Bed to Bench. 2023;16(1):486.
Brusciano L, Brillantino A, Flagiello L, Pennacchio M, Gambardella C, Lucido FS, et al. Effectiveness of perineal pelvis rehabilitation combined with biofeedback and radiofrequency diathermy (RDF) in anorectal functional pain syndromes associated with paradoxical contraction of the levator ani muscles. A prospective study. Arquivos de Gastroenterologia. 2023;60(2):201-7.