Department of Pediatric Surgery, 2nd Hospital of Shandong University, Shandong 250033, China.
J Pediatr Surg. 2009 Dec;44(12):2384-7. doi: 10.1016/j.jpedsurg.2009.07.062.
The purpose of this study is to discuss the effect of pelvic floor muscle training on fecal incontinence.
A retrospective study was performed on patients who received pelvic floor muscle training from March 2002 to April 2007. There were 55 patients with fecal incontinence (male, 32 cases; female, 23 cases; mean age, 9.4 years old from 6 to 14), including 39 cases of anorectal malformation and 16 cases of Hirschsprung's disease. Pelvic floor muscle training was performed using biofeedback for 2 weeks in hospital, 2 times each day, and 30 minutes each time. The patients were then instructed to carry out self-training at home without the biofeedback device daily and received training evaluations in the hospital outpatient department monthly. All patients completed the training regimen and were followed up for 1 year. Anal manometry and clinical score were evaluated before and after training.
Anal continence of 30 patients had satisfactory improvement, but not for the other 25 cases after training. The mean anal squeeze pressures of the group that had good results and the group that had poor results were 98.4 +/- 7.3 and 47.4 +/- 13.6 mm Hg, respectively, before training. There were 31 patients whose anal squeeze pressures were above 80 mm Hg, and 26 of these had satisfactory anal continence improvement, including all patients with Hirschsprung's disease. On the contrary, only 4 of 24 cases whose anal squeeze pressure was below 80 mm Hg acquired satisfactory anal continence improvement.
Pelvic floor muscle training could achieve good results in some patients with fecal incontinence. Baseline measurements during anorectal manometry appear to provide good prediction of prognosis and effective management.
本研究旨在探讨盆底肌训练对粪便失禁的影响。
对 2002 年 3 月至 2007 年 4 月期间接受盆底肌训练的患者进行回顾性研究。共有 55 例粪便失禁患者（男 32 例，女 23 例；平均年龄 9.4 岁，年龄 6 至 14 岁），其中直肠肛门畸形 39 例，先天性巨结肠 16 例。患者在医院接受为期 2 周的生物反馈盆底肌训练，每天 2 次，每次 30 分钟。然后指导患者在家中进行无生物反馈设备的自我训练，并在医院门诊每月进行训练评估。所有患者均完成训练方案，并随访 1 年。训练前后进行肛门测压和临床评分评估。
30 例患者的肛门控便能力有明显改善，但另外 25 例患者训练后无改善。训练效果好的组和效果差的组的平均肛门收缩压分别为 98.4±7.3mmHg 和 47.4±13.6mmHg，训练前。31 例患者的肛门收缩压高于 80mmHg，其中 26 例患者的肛门控便能力有明显改善，包括所有先天性巨结肠患者。相反，24 例肛门收缩压低于 80mmHg 的患者中仅有 4 例获得满意的肛门控便能力改善。
盆底肌训练可使部分粪便失禁患者获得良好效果。肛门测压时的基线测量似乎可以对预后提供良好的预测，并进行有效的管理。
