Background & Aims

Anorectal biofeedback (BF) is commonly used to treat patients with fecal incontinence (FI), but demand usually exceeds availability. It is therefore important to identify patients most likely to respond to BF treatment. We aimed to identify pre-treatment clinical or physiologic factors that might be used to predict completion and success of BF in women with FI.

Methods

We analyzed data from 400 women with FI (mean age, 61 ± 14 y) undergoing instrumental BF in a tertiary care setting from 2003 through 2016. All patients completed questionnaires before BF, including Rome and the hospital anxiety and depression scale questionnaires. Histories of medication use, surgery, medical conditions, and bowel pattern were recorded, urge was assessed, and patients kept stool diaries. Before and after treatment (6 weekly sessions with a gastroenterologist-supervised nurse specialist, 4 involving instrumented anorectal biofeedback), patients were examined by a physician and fecal incontinence severity index and visual analogue scale scores were recorded. The main outcome measure was response to therapy, defined as improvement of 50% or more in weekly FI episodes at the end of BF compared with before BF.

Results

The BF treatment was completed by 363 women (91%); of these, 62 had low baseline symptom frequency (no FI episodes in the 2 weeks before BF). Younger age was associated with failure to complete treatment. Of the 301 patients remaining, 202 patients (67%) had a response to therapy; among these women, urge FI was associated with response at end of BF, but not at follow up (6 months after therapy). Baseline severity of symptom scores and quality of life measures were associated with greater improvement in the same variable at the end of BF and after 6 months. Patients with low baseline symptom frequency improved in all secondary outcome measures, similar to patients with higher baseline symptom frequency.

Conclusions

In an analysis of 363 women with FI, approximately two-thirds had a response to BF treatment. Urge FI was the only baseline variable associated with response. Baseline severity of symptoms and quality of life measures were associated with greater improvement in the same variable, but not overall response. It is therefore a challenge to select treatment for patients with FI.

中文翻译：

---

与大便失禁患者肛门直肠生物反馈治疗反应相关的因素

背景与目标

肛门直肠生物反馈 (BF) 通常用于治疗大便失禁 (FI) 患者，但需求通常超过可用性。因此，确定最有可能对 BF 治疗有反应的患者非常重要。我们旨在确定可用于预测 FI 女性 BF 完成和成功的治疗前临床或生理因素。

方法

我们分析了 2003 年至 2016 年在三级医疗机构中接受工具性 BF 的 400 名 FI 女性（平均年龄，61 ± 14 岁）的数据。所有患者在 BF 之前完成了问卷，包括罗马和医院焦虑和抑郁量表问卷。记录药物使用、手术、医疗条件和排便模式的历史，评估冲动，并记录患者的大便日记。治疗前后（每周 6 次由胃肠病学家监督的护士专家进行，4 次涉及仪器化的肛门直肠生物反馈），患者接受医生检查，并记录大便失禁严重程度指数和视觉模拟量表评分。主要结局指标是对治疗的反应，定义为与 BF 之前相比，BF 结束时每周 FI 发作改善 50% 或更多。

结果

363 名女性（91%）完成了 BF 治疗；其中，62 人的基线症状频率较低（BF 前 2 周内无 FI 发作）。年龄较小与未能完成治疗有关。在剩余的 301 名患者中，202 名患者 (67%) 对治疗有反应；在这些女性中，紧急 FI 与 BF 结束时的反应相关，但与随访（治疗后 6 个月）无关。症状评分和生活质量指标的基线严重程度与 BF 结束时和 6 个月后相同变量的更大改善相关。与基线症状频率较高的患者相似，基线症状频率低的患者在所有次要结局指标中均有所改善。

结论

在对 363 名 FI 女性的分析中，大约三分之二的人对 BF 治疗有反应。Urge FI 是唯一与反应相关的基线变量。症状的基线严重程度和生活质量指标与同一变量的更大改善有关，但与总体反应无关。因此，为 FI 患者选择治疗方法是一个挑战。