Miner P B, Donnelly T C, Read N W
Sub-Department of Human Gastrointestinal Physiology and Nutrition, Royal Hallamshire Hospital, Sheffield, U.K.
Dig Dis Sci. 1990 Oct;35(10):1291-8. doi: 10.1007/BF01536422.
A study was carried out in 25 incontinent patients to evaluate some of the factors thought to be responsible for the success of retraining for fecal incontinence. Subjects were initially allocated to one of two groups; one group was trained to perceive small rectal volumes (active retraining), the other group carried out the same maneuvers but were not given any information or instruction. Active sensory retraining reduced the sensory threshold from 32 +/- 8 to 7 +/- 2 ml (P less than 0.001), corrected any sensory delay that was present (P less than 0.004), and reduced the frequency of incontinence from 5 +/- 1 to 1 +/- 1 episodes per week (P less than 0.01). Sham retraining caused a modest reduction in the sensory threshold (from 29 +/- 9 to 20 +/- 8; P less than 0.05) but did not significantly reduce the frequency of incontinence. Subsequent strength and coordination training did not significantly improve continence, although at the end of the study, 50% of patients had no incontinent episodes at all and 76% of patients had reduced the frequency of incontinence episodes by more than 75%. This improvement in continence was not associated with any change in sphincter pressures or in the continence to rectally infused saline but was associated with significant improvements in rectal sensation. The functional improvement was sustained over a period of two years in 16 of the 22 patients available for follow-up. In conclusion, the results support the use of retraining in the management of fecal incontinence and suggest that retraining may work by enhancing rectal sensitivity and instilling confidence.
对25例大便失禁患者进行了一项研究，以评估一些被认为对大便失禁再训练成功起作用的因素。受试者最初被分为两组；一组接受感知小直肠容量的训练（主动再训练），另一组进行相同的动作，但未得到任何信息或指导。主动感觉再训练使感觉阈值从32±8毫升降至7±2毫升（P<0.001），纠正了存在的任何感觉延迟（P<0.004），并使失禁频率从每周5±1次降至1±1次（P<0.01）。假再训练使感觉阈值有适度降低（从29±9降至20±8；P<0.05），但未显著降低失禁频率。随后的力量和协调性训练并未显著改善控便能力，尽管在研究结束时，50%的患者完全没有失禁发作，76%的患者失禁发作频率降低了75%以上。控便能力的这种改善与括约肌压力或直肠注入生理盐水的控便能力的任何变化无关，但与直肠感觉的显著改善有关。在可供随访的22例患者中，有16例患者的功能改善持续了两年。总之，结果支持在大便失禁管理中使用再训练，并表明再训练可能通过增强直肠敏感性和树立信心起作用。
