Biofeedback Training Fecal Incontinence in Children
Condition: Fecal Incontinence in Children
MeSH terms: Fecal Incontinence
Study type: Interventional

Summary: 
      Fecal incontinence (FI) is the inability to control bowel movements, causing stool to leak
      from rectum it ranges from an occasional leakage of stool while passing gas to a complete
      loss of bowel control after the age of 4 years1. Functional non-retentive fecal incontinence
      (FNRFI) is fecal incontinence in a child with a mental age of more than 4 years with no
      evidence of metabolic, inflammatory, or anatomical cause2.

      The long-term result of biofeedback therapy is one of the most important subjects of
      controversy, and few studies have extended to 2 years of follow-up 11. So, the purpose of
      this study was to evaluate quantitatively the short-term and long-term efficacy of
      biofeedback training as a treatment tool designed to control functional non-retentive fecal
      incontinence in children and its long term impact on the quality of life.
    

Detailed description: 
      Functional non-retentive fecal incontinence (FNRFI) is fecal incontinence in a child with a
      mental age of more than 4 years with no evidence of metabolic, inflammatory, or anatomical
      cause2.

      It is an extremely embarrassing and psychologically frustrating shameful problem with a bad
      impact on children3. It can lead to social isolation, loss of self-confidence, depression,
      and behavioral problems4. The underlying mechanism of functional non-retentive fecal
      incontinence is largely unknown. The pathophysiology seems to be complex and it is considered
      to be a multifactorial disorder5. Approximately 95% of the children had no organic cause and
      these children are considered to have a functional defecation disorder. Of this, in
      approximately 80% of these children FI is results of constipation and is treated with
      laxatives, the remaining 20% without signs of fecal retention is classified as FNRFI6 The
      negative psychological and social impact for these children is high, however, and requires
      adequate intervention7. Biofeedback therapy is a feasible option that has been used for fecal
      incontinence over several decades8. The underlying premise of biofeedback, as with learning
      any physical activity, is that "practice makes perfect" if the learner is provided with
      accurate feedback to make adjustments to optimize performance So, the purpose of this study
      was to evaluate quantitatively the short-term and long-term efficacy of biofeedback training
      as a treatment tool designed to control functional non-retentive fecal incontinence in
      children and its long term impact on the quality of life.

      Methods:

      The present study included 100 children of both sexes that were included with an age ranged
      from (5-14 years) with FNRFI with normal bowel habits, normal defecation frequency, and
      normal stool consistency with incontinence score ranging from 6-24 according to Vaizey score
      12. Exclusion criteria included; children who have traumatic sphincter injury, fecal
      impaction, spinal diseases causing incontinence, anorectal malformation, and children who
      were not cooperative. Patients included in this study were randomly divided and allocated
      into two groups Control group and Study group. Written informed consent was obtained from
      parents of all included children.

      A detailed history was taken including bowel habits, duration history of trauma. Complete
      physical examination to exclude patients requiring surgical correction.
    

Intervention name(s): Traditional Treatment; Biofeedback
Intervention type(s): Procedure; Device
Intervention description(s): Patients belonging to the control group received conventional physical therapy program in the form of:
Dietetic Regulation: The diet was given in the form of the bulk-forming diet, fruits, vegetables, cereals, and bran.
Pelvic floor muscle exercises (Kegal exercises): The patient was instructed to lie crock lying position with knees bent. He/she was instructed to pull his/her pelvic muscles upward and inward and hold the contraction for 6 seconds as if to hold back a defecation movement, followed by relaxation for 6 seconds. The exercise was repeated 25 times. Gradually increase the time until reaching 10 seconds of contraction and relaxation for each with repetition up to 30 times. The exercises applied twice per week for 3 months.; Patients belonging to the study group were subjected to the same conventional physical therapy program in addition to biofeedback training.
Biofeedback was planned after full guardians' education. Local hygiene for perianal skin for soiling episodes and using zinc oxide cream to prevent excoriation. Biofeedback was done using two types of catheters; a 24-channel water-perfused catheter with latex balloon for sensory training and a double-lumen rectal PVC balloon clothed catheter (MMS U-72210) for strength training. Each biofeedback session took 30 minutes with two sessions per week for 3 months.
Other intervention name(s): Diet and exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The present study included 100 children of both sexes that were included with an age ranged from (5-14 years) with FNRFI with normal bowel habits, normal defecation frequency, and normal stool consistency with incontinence score ranging from 6-24 according to Vaizey score 12. Exclusion criteria included; children who have traumatic sphincter injury, fecal impaction, spinal diseases causing incontinence, anorectal malformation, and children who were not cooperative. Patients included in this study were randomly divided and allocated into two groups Control group and Study group. Written informed consent was obtained from parents of all included children.
A detailed history was taken including bowel habits, duration history of trauma. Complete physical examination to exclude patients requiring surgical correction
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Fecal incontinence; Biofeedback; long-term; Children