Skip to main content

Electrical Stimulation, Biofeedback, and Other Rehabilitative Techniques

  • Chapter
  • First Online:
Electrical Stimulation for Pelvic Floor Disorders
  • 1566 Accesses

Abstract

The aim of this chapter is to describe rehabilitative techniques and their clinical impacts on fecal incontinence and obstructed defecation. Anal electric stimulation, biofeedback, pelvic floor muscle training, and sensory retraining have been used to treat the symptoms of people with these fecal disorders. Many patients may be cured and their quality of life improves. Moreover, rehabilitation offers a harmless mode for identifying those “nonresponder patients” who should be next in line for more invasive and expensive therapeutic procedures (sacral neuromodulation, surgery).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Khaikin M, Wexner SD (2006) Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol 28:3168–3173

    Google Scholar 

  2. Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J (2010) Management of fecal incontinence in adults. Neurourol Urodyn 29:199–206

    Article  PubMed  CAS  Google Scholar 

  3. Heymen S, Jones KR, Ringel Y, Scarlett Y, Whitehead WE (2001) Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum 44:728–736

    Article  PubMed  CAS  Google Scholar 

  4. Pucciani F, Raggioli M, Ringressi MN (2012) Obstructed defecation: what is the role of rehabilitation? Colorectal Dis 14:474–479

    Article  PubMed  CAS  Google Scholar 

  5. Caldwell KP (1963) The electrical control of sphincter incompetence. Lancet 2:174–175

    Article  PubMed  CAS  Google Scholar 

  6. Haskell B, Rovner H (1967) Electromyography in the management of the incompetent anal sphincter. Dis Colon Rectum 10:81–84

    Article  PubMed  CAS  Google Scholar 

  7. Healy C, Brannigan AE, Connolly EM, Eng M, O’Sullivan MJ, McNamara DA, Cusack C, Deasy JM (2006) The effects of low-frequency endo-anal electrical stimulation on faecal incontinence: a prospective study. Int J Colorectal Dis 21:802–806

    Article  PubMed  Google Scholar 

  8. Norton C, Gibbs A, Kamm MA (2006) Randomized controlled trial of anal electrical stimulation for fecal incontinence. Dis Colon Rectum 49:190–196

    Article  PubMed  Google Scholar 

  9. Larpent JL, Cuer JC, Da Poigny M (1987) Clinical and manometric results of electrical stimulation in patients with anal incontinence. Tech Coloproctol 3:183–184

    Google Scholar 

  10. Pescatori M, Pavesio R, Anastasio G, Daini S (1991) Transanal electrostimulation for fecal incontinence: clinical. Psychologic and manometric prospective study. Dis Colon Rectum 34:540–545

    Article  PubMed  CAS  Google Scholar 

  11. Osterberg A, Graf W, Eeg-Olofsson K, Hallden M, Pahlman L (1999) Is electrostimulation of the pelvic floor an effective treatment for neurogenic fecal incontinence? Scand J Gastroenterol 34:319–324

    Article  PubMed  CAS  Google Scholar 

  12. Leroy AM, Karoui S, Touchais JY, Berkelmans I, Denis P (1999) Electrostimulation is not a clinically effective treatment of anal incontinence. Eur J Gastroenterol Hepatol 11:1045–1047

    Article  Google Scholar 

  13. Surh S, Kienle P, Stern J, Herfarth C (1998) Passive electrostimulation therapy of the anal sphincter is inferior to active biofeedback training. Lagenbecks Arch Chir Suppl Kongressbd 115:976–978

    CAS  Google Scholar 

  14. Kienle P, Weitz J, Koch M, Brenner A, Herfath C, Schmidt J (2003) Biofeedback versus electrostimulation in treatment of anal sphincter insufficiency. Dig Dis Sci 48:1607–1613

    Article  PubMed  Google Scholar 

  15. Hosker G, Cody JD, Norton CC (2007) Electrical stimulation for faecal incontinence in adults. Cochrane Database Syst Rev (1). doi:10.1002/14651858.CD001310.pub2

  16. Boselli AS, Pinna F, Cecchini S, Costi R, Marchesi F, Violi V, Sarli L, Roncoroni L (2010) Biofeedback therapy plus anal electrostimulation for fecal incontinence: prognostic factors and effects on anorectal physiology. World J Surg 34:815–821

    Article  PubMed  Google Scholar 

  17. Norton C, Cody JD (2012) Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev (7). doi:10.1002/14651858.CD002111.pub3

  18. Schwandner T, Hemmelmann C, Heimert T, Kierer W, Kolbert G, Vonthein R, Weinel R, Hirschburger M, Ziegler A, Padberg W (2011) Triple-target treatment versus low-frequency electrostimulation for anal incontinence: a randomized, controlled trial. Dtsch Arztebl Int 108:653–660

    PubMed  PubMed Central  Google Scholar 

  19. Pucciani F, Iozzi L, Masi A, Cianchi F, Cortesini C (2003) Multimodal rehabilitation of faecal incontinence: experience of an Italian centre devoted to faecal disorder rehabilitation. Tech Coloproctol 7:139–147

    Article  PubMed  CAS  Google Scholar 

  20. Vonthein R, Heimerl T, Schwandner T, Ziegler A (2013) Electrical stimulation and biofeedback for the treatment of fecal incontinence: a systematic review. Int J Colorectal Dis 28:1567–1577

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chiarioni G, Chistolini F, Menegotti M, Salandini L, Vantini I, Morelli A, Bassotti G (2004) One-year follow-up study on the effects of electrogalvanic stimulation in chronic idiopathic constipation with pelvic floor dyssynergia. Dis Colon Rectum 47:346–353

    Article  PubMed  Google Scholar 

  22. Nicastro A, Stella LP, Nicolai AP (2006) Constipation. Proposal for a new classification and therapy. Chir Ital 58:203–212

    PubMed  Google Scholar 

  23. Engel BT, Nikoomanesh P, Schuster MM (1974) Operant conditioning of rectosphincteric response in the treatment of fecal incontinence. N Engl J Med 190:646–649

    Article  Google Scholar 

  24. Marcello PW, Barrett RC, Coller JA, Schoetz DJ Jr, Roberts PL, Murray JJ, Rusin LC (1998) Fatigue rate index as a new measurement of external sphincter function. Dis Colon Rectum 41:336–343

    Article  PubMed  CAS  Google Scholar 

  25. Palsson OS, Heymen S, Whitehead WE (2004) Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback 29:153–174

    Article  PubMed  Google Scholar 

  26. Loening-Baucke V (1990) Biofeedback therapy for fecal incontinence. Dig Dis 8:112–124

    Article  PubMed  CAS  Google Scholar 

  27. Pucciani F, Rottoli ML, Bologna A, Cianchi F, Forconi S, Cutellè M, Cortesini C (1998) Pelvic floor dyssynergia and bimodal rehabilitation: results of combined pelviperineal kinesitherapy and biofeedback training. Int J Colorectal Dis 13:124–130

    Article  PubMed  CAS  Google Scholar 

  28. Schwandner T, König IR, Heimerl T, Kierer W, Roblick M, Bouchard R, Unglaube T, Holch P, Ziegler A, Kolbert G (2010) Triple target treatment (3T) is more effective than biofeedback alone for anal incontinence: the 3T-AI study. Dis Colon Rectum 53:1007–1016

    Article  PubMed  Google Scholar 

  29. Rao SSC, Welcher KD, Pelsang RE (1997) Effects of biofeedback therapy on anorectal function in obstructive defecation. Dig Dis Sci 42:2197–2205

    Article  PubMed  CAS  Google Scholar 

  30. Byoung HL, Nayoung K, Sung-Bum K, So Yeon K, Kyoung–HO L, Bo Youn I, Jung Hee J, Jane C, Young Soo P, Dong Ho L (2010) The long-term clinical efficacy of biofeedback therapy for patients with constipation or fecal incontinence. J Neurogastroenterol Motil 16:177–185

    Article  Google Scholar 

  31. Lacima G, Pera M, Amador A, Escaramis G, Piqué JM (2010) Long-term results of biofeedback treatment for faecal incontinence: a comparative study with untreated controls. Colorectal Dis 12:742–749

    Article  PubMed  CAS  Google Scholar 

  32. Battaglia E, Serra AM, Buonafede G, Dughera L, Chistolini F, Morelli A, Emanuelli G, Bassotti G (2004) Long-term study on the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and slow transit constipation. Dis Colon Rectum 47:90–95

    Article  PubMed  Google Scholar 

  33. Lewicky-Gaupp C, Morgan DM, Chey WD, Muellerleile P, Fenner DE (2008) Successful physical therapy for constipation related to puborectalis dyssynergia improves symptom severity and quality of life. Dis Colon Rectum 51:1686–1691

    Article  PubMed  Google Scholar 

  34. Harewood GC, Coulie B, Camilleri M, Rath-Harvey D, Pemberton JH (1999) Descending perineum syndrome: audit of clinical and laboratory features and outcome of pelvic floor retraining. Am J Gastroenterol 94:126–130

    Article  PubMed  CAS  Google Scholar 

  35. Gosselink MJ, Schouten MR (2001) Rectal sensory perception in females with obstructed defecation. Dis Colon Rectum 44:1337–1344

    Article  PubMed  CAS  Google Scholar 

  36. Pucciani F (2013) Faecal soiling: pathophysiology of post-defecatory incontinence. Colorectal Dis 15:987–992

    Article  PubMed  CAS  Google Scholar 

  37. Burgell RE, Scott SM (2012) Rectal hyposensitivity. J Neurogastroenterol Motil 18:373–384

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ludidi S, Conchillo JM, Keszthelyi D, Van Avesaat M, Kruimel JW, Jonkers DM, Masclee AA (2012) Rectal hypersensitivity as hallmark for irritable bowel syndrome: defining the optimal cutoff. Neurogastroenterol Motil 24:729–733

    Article  PubMed  CAS  Google Scholar 

  39. Whitehead W, Wald A, Norton J (2001) Treatment options for fecal incontinence. Dis Colon Rectum 44:131–144

    Article  PubMed  CAS  Google Scholar 

  40. Wald A (2007) Clinical practice. Fecal incontinence in adults. N Engl J Med 356:1648–1655

    Article  PubMed  CAS  Google Scholar 

  41. Peticca L, Pescatori M (2002) Outlet obstruction due to anismus and rectal hyposensation: effect of biofeedback training. Colorectal Dis 4:67

    Article  PubMed  Google Scholar 

  42. Chiarioni G, Bassotti G, Stanganini S, Vantini I, Whitehead WE (2002) Sensory retraining is the key to biofeedback therapy for formed stool incontinence. Am J Gastroenterol 97:109–117

    Article  PubMed  CAS  Google Scholar 

  43. Ozturk L, Niazi S, Stessman M, Rao SS (2004) Long-term outcome and objective changes of anorectal function after biofeedback therapy for faecal incontinence. Aliment Pharmacol Ther 20:667–674

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Filippo Pucciani .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Pucciani, F. (2015). Electrical Stimulation, Biofeedback, and Other Rehabilitative Techniques. In: Martellucci, J. (eds) Electrical Stimulation for Pelvic Floor Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-06947-0_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-06947-0_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-06946-3

  • Online ISBN: 978-3-319-06947-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics