Advertisement

Rehabilitation and Biofeedback

  • Filippo Pucciani

Abstract

Fecal continence depends on the interaction of many factors. Anal sphincters, pelvic floor muscles, anal sensation, rectal sensory-motor activity, and neural integrity all have determinant roles, which together provide a coordinated mechanism of gas and stool continence. The pathophysiology of fecal incontinence is, therefore, often multifactorial, and each patient has his or her own specific pathogenetic profile as a result of a mix of etiological factors. It is clear that any treatment for fecal incontinence must allow for this fundamental aspect, and each patient thus requires a clinical approach that has been modulated on his or her specific incontinence etiology. This basic fact must be considered when planning therapy for a patient with fecal incontinence.

Keywords

Pelvic Floor Fecal Incontinence Anal Sphincter Pelvic Floor Muscle External Anal Sphincter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Norton C, Kamm MA (2001) Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults. Aliment Pharmacol Ther 15:1147–1154PubMedCrossRefGoogle Scholar
  2. 2.
    Whitehead W, Wald A, Norton J (2001) Treatment options for fecal incontinence. Dis Colon Rectum 44:131–144PubMedCrossRefGoogle Scholar
  3. 3.
    Tries J (2004) Protocol-and therapist-related variables affecting outcomes of behavioral interventions for urinary and fecal incontinence. Gastroenterology 126(1 Suppl 1):S152-S158PubMedCrossRefGoogle Scholar
  4. 4.
    Bharucha AE (2003) Fecal incontinence. Gastroenterology 124:1672–1685PubMedCrossRefGoogle Scholar
  5. 5.
    Engel BT, Nikoomanesh P, Schuster MM (1974) Operant conditioning of rectosphincteric response in the treatment of fecal incontinence. N Engl J Med 290:646–649PubMedCrossRefGoogle Scholar
  6. 6.
    Rao SSC, Happel J, Welcher K (1996) Can biofeedback therapy improve anorectal function in fecal incontinence? Am J Gastroenterol 91:2360–2366PubMedGoogle Scholar
  7. 7.
    Ozturk R, Niazi S, Stessman M, Rao SSC (2004) Longterm outcome and objective changes of anorectal function after biofeedback therapy for faecal incontinence. Aliment Pharmacol Ther 20:667–674PubMedCrossRefGoogle Scholar
  8. 8.
    Papachrhrysostomou M, Smith AN (1994) Effects of biofeedback on obstructive defecation. Reconditioning of the defecation reflex? Gut 35:252–256CrossRefGoogle Scholar
  9. 9.
    Chiarioni G, Bassotti G, Stanganini S et al (2002) Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. Am J Gastroenterol 97:109–117PubMedCrossRefGoogle Scholar
  10. 10.
    Fernandex-Fraga X, Azpiroz F, Malagelada J-R (2002) Significance of pelvic floor muscles in anal incontinence. Gastroenterology 123:1441–1450CrossRefGoogle Scholar
  11. 11.
    Miner PB, Donnelly TC, Read NW (1990) Investigation of mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 35:1291–1298PubMedCrossRefGoogle Scholar
  12. 12.
    Enck P (1993) Biofeedback training in disordered defecation: a critical review. Dig Dis Sci 38:1953–1960PubMedCrossRefGoogle Scholar
  13. 13.
    Heymen S, Jones KR, Ringel Y et al (2001) Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum 44:728–736PubMedCrossRefGoogle Scholar
  14. 14.
    Kegel AH (1952) Stress incontinence and genital relaxation; a nonsurgical method of increasing the tone of sphincters and their supporting structures. Clin Symp 4:35–51PubMedGoogle Scholar
  15. 15.
    Pucciani F, Rottoli ML, Bologna A et al (1998) Pelvic floor dyssynergia and bimodal rehabilitation: results of combined pelviperineal kinesitherapy and biofeedback training. Int J Colorect Dis 13:124–130CrossRefGoogle Scholar
  16. 16.
    Di Benedetto P (2004) Chinesiterapia pelvi-perineale: generalità. In: Di Benedetto P (ed) Riabilitazione uroginecologica. Edizioni Minerva Medica (II Edizione), Torino, pp 177–179Google Scholar
  17. 17.
    Harewood GC, Coulie B, Camilleri M et al (1999) Descending perineum syndrome: audit of clinical and laboratory features and outcome of pelvic floor retraining. Am J Gastroenterol 94:126–130PubMedCrossRefGoogle Scholar
  18. 18.
    Sander P, Bjarnesen J, Mouritsen L, Fuglsang-Frederiksen A (1999) Anal incontinence after obstetric third-/fourth-degree laceration. One-year follow-up after pelvic floor exercises. Int Urogynecol J Pelvic Floor Dysfunction 10:177–181CrossRefGoogle Scholar
  19. 19.
    Pucciani F, Iozzi L, Masi A et al (2003) Multimodal rehabilitation for faecal incontinence: experience of an Italian centre devoted to faecal disorder rehabilitation. Tech Coloproctol 7:139–147PubMedCrossRefGoogle Scholar
  20. 20.
    Buser WD, Miner PB Jr (1986) Delayed rectal sensation with fecal incontinence. Successful treatment using anorectal manometry. Gastroenterology 91:1186–1191PubMedGoogle Scholar
  21. 21.
    Sun WM, Read NW, Miner PB (1990) Relation between rectal sensation and anal function in normal subjects and patients with fecal incontinence. Gut 31:807–813CrossRefGoogle Scholar
  22. 22.
    Bentsen D, Braun JW (1996) Controlling fecal incontinence with sensory retraining managed by advanced practice nurses. Clin Nurse Spec 10:171–175PubMedCrossRefGoogle Scholar
  23. 23.
    Leroi AM, Karoui S, Touchais JY et al (1999) Electrostimulation is not a clinically effective treatment of anal incontinence. Eur J Gastroenterol Hepatoll 1:1045–1047CrossRefGoogle Scholar
  24. 24.
    Surh S, Kienle P, Stern J, Herfarth C (1998) Passive electrostimulation therapy of the anal sphincter is inferior to active biofeedback training. Langensbeck Arch Chir Suppl Kongrssbd 115:976–978Google Scholar
  25. 25.
    Hosker G, Norton C, Brazzelli M (2000) Electrical stimulation for faecal incontinence in adults. Cochrane Database Syst Rev (2):CD0001310Google Scholar
  26. 26.
    Norton C, Gibbs A, Kamm MA (2006) Randomized, controlled trial of anal electrical stimulation for fecal incontinence. Dis Colon Rectum 49:190–196PubMedCrossRefGoogle Scholar
  27. 27.
    Jost WF (1998) Electrostimulation in fecal incontinence. Relevance of the sphincteric compound muscle action potential. Dis Colon Rectum 41:590–592PubMedCrossRefGoogle Scholar
  28. 28.
    Österberg A, Graf W, Eeg-Olofsson K et al (1999) Is electrostimulation of the pelvic floor an effective treatment for neurogenic faecal incontinence? Scand J Gastroenterol 34:319–324PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Filippo Pucciani

There are no affiliations available

Personalised recommendations