Biofeedback Vs Electrical Stimulation in Treatment of Fecal Incontinence
Condition: Fecal Incontinence; Encopresis; Fecal Soiling
MeSH terms: Fecal Incontinence; Encopresis
Study type: Interventional

Summary: 
      Fecal incontinence is one of the most psychological frustrating problems. It occurs in
      children due to many causes. There is a wide range of non-invasive therapeutic approaches
      like Kegel exercise, Biofeedback, and posterior tibial nerve stimulation. However, up till
      now, there are no established guidelines for treatment.

      the objective of this study is to evaluate and compare the early effect of Biofeedback
      therapy versus bilateral transcutaneous posterior tibial nerve stimulation (TPNS) as
      non-invasive methods in the treatment of functional non-retentive fecal incontinence (FNRFI)
      in children.
    

Detailed description: 
      Functional non-retentive fecal incontinence (FNRFI) requires prolonged treatment with a wide
      range of non-invasive therapeutic approaches like Kegel exercise, Biofeedback, and posterior
      tibial nerve stimulation (PTNS). However, up till now, there are no established guidelines
      for treatment.1 The aim of this study is to evaluate and compare the early effect of
      Biofeedback therapy versus bilateral transcutaneous posterior tibial nerve stimulation
      (TPTNS) as non-invasive methods in the treatment of (FNRFI) in children.

      Methodology: The current prospective randomized controlled study included 93 children with
      FNRFI who were randomly divided and allocated into three groups. Group A treated by
      conventional methods through dietetic regulation and Kegal exercises. Group B treated by
      biofeedback therapy while group C received bilateral (TPTNS). Initial manometric findings
      including resting pressure, squeeze pressure, 1st sensation, 1st urge, and intense urge were
      recorded and repeated after 3 and 6 months together with incontinence score recorded in using
      St' Mark's (Varizey) with the primary endpoint of improvement of the incontinence score more
      than 50%.
    

Intervention name(s): Biofeedback; Electrical stimulation; Traditional treatment
Intervention type(s): Device; Device; Other
Intervention description(s): Biofeedback therapy in addition to the conventional measures done in the control Group. It was performed in the same position used for baseline manometry. The used protocol included strength and sensory training, twice weekly for 3 months. Strength training was performed by a double-lumen rectal PVC balloon clothed catheter (MMS U-72210).; A positive auto adhesive electrode was applied above the medial malleolus over the S3 dermatome. A second negative electrode was applied just below the same malleolus. Both electrodes were linked to an electrical stimulation device ( EMS physio Ltd, OX129 F, England) with a low frequency current (10 Hz), and adjustable intensity.; Conventional treatment through Kegal exercises and dietetic regulation where they had received bulky food including vegetables, fruits bran and cereals. Fast foods, spicy drinks and caffeine should be limited in child's diet. Local hygiene and zinc oxide application to the perianal skin were advised to prevent skin excoriation.
Other intervention name(s): Posterior tibial nerve stimulation; Exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The current prospective randomized controlled study included 93 children with FNRFI who were randomly divided and allocated into 3 groups. were managed by conventional methods through Kegal exercises and dietetic regulation where they had received bulky food including vegetables, fruits bran and cereals. Fast foods, spicy drinks and caffeine should be limited in child's diet. Local hygiene and zinc oxide application to the perianal skin were advised to prevent skin excoriation.Biofeedback group treated by biofeedback therapy in addition to traditional treatment, while the third group is the electrical stimulation group received bilateral (TPTNS) in addition to the traditional treatment. Initial manometric findings including resting pressure (mm hg), squeeze pressure (mm hg), 1st sensation (cm water), 1st urge (cm water), and intense urge (cm water) were recorded and repeated after 3 and 6 months together with incontinence score recorded in using St' Mark's (Varizey).
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Fecal incontinence; Biofeedback; Transcutaneous posterior tibial nerve stimulation; Childern