Efficacy of pelvic floor muscle training for the treatment of fecal incontinence after Soave procedure for Hirschsprung disease

Abstract

Objective: The main objective of this study is to evaluate the efficacy of pelvic floor muscle exercise for the treatment of fecal incontinence after Soave procedure for Hirschsprung disease (HD).

Methods: A case series study was performed in 24 incontinent children after Soave pull-through surgery for HD. Out of the 24 patients, 16 patients (training group) received pelvic floor muscle training while the other 8 patients (control group) did not receive further treatment. For children who received pelvic floor muscle training, biofeedback treatment was given for 2 weeks in hospital and they were then instructed to carry out pelvic floor muscle exercise at home. At the baseline and after 1 year of training, anorectal manometry was performed to measure resting anal canal pressure, squeeze pressure, and rectal sensation. Efficacy of pelvic floor muscle exercise for the treatment of postoperative fecal incontinence was evaluated by the difference between baseline and 1-year follow-up values. At the baseline, the characteristics of the incontinent children were also compared with 18 children who were performed Soave operation for HD and had normal anal function.

Results: Lower resting anal canal pressure distinguished the incontinent children from the continent ones. Resting pressure of the incontinent children was significantly improved by pelvic floor muscle exercise: the baseline and 1-year follow-up values of the treatment group were 18.6 ± 6.2 and 35.4 ± 8.7 mm Hg, respectively. Squeeze pressure and clinical outcomes were also improved after the pelvic floor muscle training: only 3 out of the 16 patients had occasional soiling after the training. No significant changes in clinical outcome and manometry measurements were observed in the control group.

Conclusions: The damage of internal anal sphincter might be one of the causes of fecal incontinence after Soave procedure. The damage of internal anal sphincter could be caused by lower level of dissection, vigorous anal dilation, and excessive anal canal traction during operation. Pelvic floor muscle training is one procedure of choice to treat this complaint.