Rao S S, Welcher K D, Happel J
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.
Am J Gastroenterol. 1996 Nov;91(11):2360-6.
Although biofeedback treatment ameliorates symptoms in patients with fecal incontinence, whether it improves anorectal function is unclear.
To examine prospectively whether biofeedback therapy influences objective and subjective parameters of anorectal function and whether it improves outcome.
Nineteen consecutive patients (females = 17) with fecal incontinence for over 1 year, underwent a three-phase outpatient treatment program. This program consisted of pelvic muscle strengthening exercises (phase 1), 1-h biofeedback therapy sessions twice a week (phase 2), and reinforcement sessions at 6 wk, 3, 6, and 12 months (phase 3). The number of sessions in phase 2 were customized for each patient. Anorectal manometry, saline continence test, prospective stool diaries, and bowel satisfaction scores were used to assess the changes in bowel function before and 1 year after therapy.
After biofeedback therapy, the anal squeeze sphincter pressure (p < 0.05), the duration of squeeze (p < 0.001), and the capacity to retain liquids (p < 0.05) increased. Rectoanal coordination also improved with a reduction (p < 0.001) in rectal pressure and an increase (p < 0.05) in the continence index. Threshold volumes for first perception and desire to defecate decreased (p < 0.05). The number of therapy sessions varied, mean (range) = 7 (4-13). Stool frequency and the number of incontinence episodes decreased (p < 0.001). Bowel satisfaction score improved (p < 0.001).
Biofeedback therapy is effective and improves objective and subjective parameters of anorectal function in patients with fecal incontinence. Customizing the number of sessions and providing periodic reinforcement may improve the success rate.
尽管生物反馈疗法可改善大便失禁患者的症状，但它是否能改善肛门直肠功能尚不清楚。
前瞻性地研究生物反馈疗法是否会影响肛门直肠功能的客观和主观参数，以及是否能改善治疗效果。
19例连续的大便失禁超过1年的患者（女性17例）接受了为期三个阶段的门诊治疗方案。该方案包括盆底肌肉强化锻炼（第1阶段）、每周两次1小时的生物反馈治疗（第2阶段）以及在6周、3个月、6个月和12个月时的强化治疗（第3阶段）。第2阶段的治疗次数根据每位患者的情况定制。采用肛门直肠测压、盐水控便试验、前瞻性大便日记和肠道满意度评分来评估治疗前及治疗1年后肠道功能的变化。
生物反馈治疗后，肛门收缩括约肌压力（p < 0.05）、收缩持续时间（p < 0.001）和液体保留能力（p < 0.05）增加。直肠肛门协调性也得到改善，直肠压力降低（p < 0.001），控便指数增加（p < 0.05）。首次感知和排便欲望的阈值体积降低（p < 0.05）。治疗次数各不相同，平均（范围）= 7（4 - 13）次。大便频率和失禁发作次数减少（p < 0.001）。肠道满意度评分提高（p < 0.00）。
生物反馈疗法有效，可改善大便失禁患者肛门直肠功能的客观和主观参数。定制治疗次数并提供定期强化治疗可能会提高成功率。
