Combination Therapy With Biofeedback, Loperamide and Stool Bulking Agents

Combination Therapy With Biofeedback, Loperamide and Stool Bulking Agents is Effective for the Treatment of Fecal Incontinence in Women - a Randomized Controlled Trial

Background: Biofeedback and medical treatments have been extensively used for moderate fecal incontinence. There is limited data comparing and combining these two treatments. Aim: To evaluate the effect of biofeedback and medical treatments, separately and in combination. Methods: Sixty-five consecutive female patients, referred to a tertial center for fecal incontinence were included. The patients were randomized to start with either biofeedback (4-6 months) or medical treatment with loperamide and stool-bulking agents (2 months). Both groups continued with a combination treatments, i.e. medical treatment was added to biofeedback and vice versa. A two-week prospective bowel symptom diary and anorectal physiology were evaluated at baseline, after single- and combination treatments.

Inclusion Criteria: Patients older than 18 years of age Patients with at least one or more episodes of FI during a period of 2 weeks as recorded by bowel function diary Patients from whom written consent was obtained Exclusion Criteria: Previous congenital or acquired spinal injury, spinal tumour or spinal surgery Presence of neurological diseases or peripheral vascular disease Uncontrolled diabetes mellitus Congenital anorectal malformations Recent colorectal or gastrointestinal surgery Presence of external full-thickness rectal prolapse Inflammatory bowel disease Chronic diarrhoea Use of tibial nerve or sacral nerve stimulations Ongoing pregnancy Any malignant disease