Evaluation of biofeedback in the rehabilitation of children suffering of fecal incontinence

Abstract EN

This study was conducted on fifty children with fecal incontinence referred to Ain Shams University Hospital.

All the patients were evaluated thoroughly, clinically through detailed history taking and general and local examination.

Electromyographic (EMG) examination of the external anal sphincter, puborectalis and levator ani muscles was done in 48 patients.

Barium enema and plain lumbo-sacral x-rays were performed for all patients.

Anorectal manometric assessment was performed for 37 patients who were older than 5 years.

CT scan was done for 2 patients and MRI in another two.

Patients were divided into 3 groups : Group I : 10 patients with idiopathic incontinence (encorporesis), Group II-A: 17 patients with incontinence following surgical correction of anorectal malformations (ARM).

Group II-B: 13 patients with incontinence following surgery for Hirschprung’s disease.

Group II-C : 2 boys with incontinence following surgery for rectal prolapse.

Group III: 8 patients with neurogenic incontinence.

Incontinence was assessed according to Kelly’s point score (1969).

All patients received medical treatment in the form of bulk forming stools and regular bowel evacuation either through a toilet training program or regular washouts by self administrated suppositories or small enemas.

Biofeedback therapy was offered to 37 patients.

Twenty-one of them were treated surgically to correct any abnormality before starting the biofeedback program.

Eight patients had anoplasty, two had redo-posterior sagittal anorectoplasty (PSARP), two had Malone procedure, two had Thiersch, four had anal dilatations under general anesthesia, two had untethering of the cord and one had Lynn’s myectomy.

Our results showed a highly significant improvement of the 37 patients who received biofeedback and for each group alone p < 0.01 except group IIA p < 0.05.

Therefore it is recommended that manometric evaluation and biofeedback therapy together with a medical program should be the management protocol in children with fecal incontinence, before any decision for sphincteric repair or muscle transplantation as long as there is no tear in the muscle complex.