Biofeedback treatment of fecal incontinence was pioneered by Drs. William Whitehead and Bernie Engel at the Johns Hopkins University Hospitals in Baltimore in the 1970s. These behaviorists used the "large balloon manometrics" developed by Dr. Marvin Schuster and colleagues, and showed that patients could easily learn to strengthen their anal sphincters to attain greater, or complete, control over fecal incontinence. Because of their early work, this therapy has been widely accepted in the Gastroenterology and Colon-Rectal fields; the same manometric systems used to evaluate sphincter control in "colorectal labs" were used to do biofeedback training. More recently, the use of more convenient intra-anal sensors (The PerryAnal™ sensor) have made this therapy even more practical. In addition, the smaller EMG sensors can be used with convenient EMG home trainers to permit considerably more biofeedback practice per week, resulting in even greater improvements in symptom control.
The majority of fecal incontinence patients have suffered an injury to the anal sphincter, either as a result of an accident, or a birth defect. Another large group developed incontinence as a result of a stroke. Almost all patients can be helped to a substantial, if not complete, recovery.
Two abstracts presented at the 1996 meeting of the American Society of Colon and Rectal Surgeons (June 9-14, in Seattle) define further progress in this field. Biofeedback in Colorectal Practice: A Multi-Center, Statewide, 3 Year Experience by Ferrara et al describes their results with 72 Fecal Incontinence patients and 116 Chronic Constipation patients - 84-85% of patients made significant improvement.
A companion paper, Electromyographic Assessment of Biofeedback Training for Fecal Incontinence and Chronic Constipation, by Espat et al is especially interesting because they are the first to show that the "endurance" test showed significant change in successful patients. Both studies were done at the Colon and Rectal Clinic of Orlando, Florida, and related centers.
A collection of comments about the new EMG treatment of fecal
incontinence is posted here under the title Key
Quotes: Fecal Incontinence and generally reflects the
favorable professional position of biofeedback in this field.
Have you thought about (treating) constipation? Is an essay that describes the dramatic progress in the past decade in the treatment of constipation. Basically, in 1985 several scientists independently came to the same conclusion --- that 50% or more of "constipation" was actually caused by muscular dyssynergia; patients inadvertently contract their anal sphincters when trying to evacuate! This condition, labeled "anismus", is extremely easy to treat with EMG biofeedback.
© 1996 by John D. Perry
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