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Meta-Analysis
. 2012 Jul 11;2012(7):CD002111.
doi: 10.1002/14651858.CD002111.pub3.

Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults

Christine Norton  1 , June D Cody
Affiliations
Meta-Analysis

Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults

Christine Norton et al. Cochrane Database Syst Rev. .

Abstract

Background: Faecal incontinence is a particularly embarrassing and distressing condition with significant medical, social and economic implications. Anal sphincter exercises (pelvic floor muscle training) and biofeedback therapy have been used to treat the symptoms of people with faecal incontinence. However, standards of treatment are still lacking and the magnitude of alleged benefits has yet to be established.

Objectives: To determine the effects of biofeedback and/or anal sphincter exercises/pelvic floor muscle training for the treatment of faecal incontinence in adults.

Search methods: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 24 January 2012) which contains trials from searching CENTRAL, MEDLINE and handsearching of conference proceedings; and the reference lists of relevant articles.

Selection criteria: All randomised or quasi-randomised trials evaluating biofeedback and/or anal sphincter exercises in adults with faecal incontinence.

Data collection and analysis: Two review authors assessed the risk of bias of eligible trials and two review authors independently extracted data from the included trials. A wide range of outcome measures were considered.

Main results: Twenty one eligible studies were identified with a total of 1525 participants. About half of the trials had low risk of bias for randomisation and allocation concealment.One small trial showed that biofeedback plus exercises was better than exercises alone (RR for failing to achieve full continence 0.70, 95% CI 0.52 to 0.94).One small trial showed that adding biofeedback to electrical stimulation was better than electrical stimulation alone (RR for failing to achieve full continence 0.47, 95% CI 0.33 to 0.65).The combined data of two trials showed that the number of people failing to achieve full continence was significantly lower when electrical stimulation was added to biofeedback compared against biofeedback alone (RR 0.60, 95% CI 0.46 to 0.78).Sacral nerve stimulation was better than conservative management which included biofeedback and PFMT (at 12 months the incontinence episodes were significantly fewer with sacral nerve stimulation (MD 6.30, 95% CI 2.26 to 10.34).There was not enough evidence as to whether there was a difference in outcome between any method of biofeedback or exercises. There are suggestions that rectal volume discrimination training improves continence more than sham training. Further conclusions are not warranted from the available data.

Authors' conclusions: The limited number of identified trials together with methodological weaknesses of many do not allow a definitive assessment of the role of anal sphincter exercises and biofeedback therapy in the management of people with faecal incontinence. We found some evidence that biofeedback and electrical stimulation may enhance the outcome of treatment compared to electrical stimulation alone or exercises alone. Exercises appear to be less effective than an implanted sacral nerve stimulator. While there is a suggestion that some elements of biofeedback therapy and sphincter exercises may have a therapeutic effect, this is not certain. Larger well-designed trials are needed to enable safe conclusions.

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Conflict of interest statement

The lead review author is an author of a study included in the review.

Figures

1
1
PRISMA study flow diagram.
1.1
1.1. Analysis
Comparison 1 Anal sphincter exercises/PFMT with or without biofeedback versus no treatment, Outcome 1 Number of people failing to achieve full continence (worse, unchanged or improved).
1.2
1.2. Analysis
Comparison 1 Anal sphincter exercises/PFMT with or without biofeedback versus no treatment, Outcome 2 Number of people with no improvement in incontinence status (worse or unchanged).
1.3
1.3. Analysis
Comparison 1 Anal sphincter exercises/PFMT with or without biofeedback versus no treatment, Outcome 3 Number of incontinence episodes per week.
1.8
1.8. Analysis
Comparison 1 Anal sphincter exercises/PFMT with or without biofeedback versus no treatment, Outcome 8 Sensory threshold (rectal balloon distension ‐ ml).
2.7
2.7. Analysis
Comparison 2 Anal sphincter exercises/PFMT with or without biofeedback versus any other treatment alone, Outcome 7 Number of people dissatisfied with the treatment.
3.1
3.1. Analysis
Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 1 Number of people failing to achieve full continence (worse, unchanged or improved).
3.4
3.4. Analysis
Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 4 Number of incontinence episodes per week.
3.5
3.5. Analysis
Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 5 Number of pad changes required per week.
3.6
3.6. Analysis
Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 6 Incontinence score.
3.15
3.15. Analysis
Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 15 General health measures.
3.16
3.16. Analysis
Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 16 Condition specific quality of life measures.
3.17
3.17. Analysis
Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 17 Psychological health measures.
3.19
3.19. Analysis
Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 19 Satisfaction with treatment (VAS).
4.1
4.1. Analysis
Comparison 4 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus exercises with or without biofeedback, Outcome 1 Number of people failing to achieve full continence (worse, unchanged or improved).
4.2
4.2. Analysis
Comparison 4 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus exercises with or without biofeedback, Outcome 2 Number of people with no improvement in incontinence status (worse or unchanged).
4.6
4.6. Analysis
Comparison 4 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus exercises with or without biofeedback, Outcome 6 Incontinence score.
5.1
5.1. Analysis
Comparison 5 Anal sphincter exercises/PFMT and biofeedback versus anal sphincter exercises/PFMT alone, Outcome 1 Number of people failing to achieve full continence (worse, unchanged or improved).
5.3
5.3. Analysis
Comparison 5 Anal sphincter exercises/PFMT and biofeedback versus anal sphincter exercises/PFMT alone, Outcome 3 Number of people dissatisfied with the treatment.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies awaiting assessment

Marshall 1995 {published data only}
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Pages 2003 {published data only}
    1. Pages I‐H, Lemke J, Grundel K. Comparison of biofeedback and electrostimulation for treatment of fecal incontinence [German]. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 2003;13(6):325‐9.

References to ongoing studies

Dehli 2009 {published data only}
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Stott 2000 {published data only}
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Additional references

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