Non-surgical management of faecal incontinence in the way of pelvic floor physical therapy with biofeedback is an important and effective treatment. It involves training patients to strengthen the pelvic floor and anal sphincters as well as dietary advice, teaching patients correct defaecatory dynamics, use of medications to firm the stools, laxatives, suppositories and rectal irrigation.
Biofeedback can be performed face to face in the office, or over the telephone, as a one-off session, or finally as a course of appointments. A recent randomised control trial by C. Young et al assessed the delivery of the biofeedback sessions in four different groups. The initial appointment for all subjects was in person. At this initial visit, the patient was assessed, and all appropriate advice is given. Following this, much of the work was performed by subjects at home with the biofeedback specialist re-enforcing advice. Group 1 received 4 monthly face-to-face biofeedback treatments, groups 2 and 3 received one face-to-face biofeedback followed by telephone biofeedback and group 4 received a once-off face-to-face biofeedback treatment.
The study demonstrated improvement in all patients with biofeedback, improving both faecal incontinence symptoms and quality of life. The improvement was no different if patients were seen in the office again following the initial treatment, or if their follow up visits were by phone. However, patient satisfaction was greater when subjects had face to face follow up as opposed to telephone interview, or no follow up at all.
This study adds to the evidence in support of biofeedback for the treatment of faecal incontinence. Apart from improving patient satisfaction, which is very important in health care, there is no further benefit to seeing patients again in the office following the initial assessment.
A Randomised Control Trial of Four Different Regimes of Biofeedback Program in the Treatment of Faecal Incontinence.
Article by Alexis Schizas on behalf of the Publications and Communications Committee