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Intervention Review

Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults

  1. Christine C Norton1,*,
  2. June D Cody2,
  3. Gordon Hosker3

Editorial Group: Cochrane Incontinence Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 22 MAY 2006

DOI: 10.1002/14651858.CD002111.pub2

How to Cite

Norton CC, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD002111. DOI: 10.1002/14651858.CD002111.pub2.

Author Information

  1. 1

    St Mark's Hospital, Physiology Unit, Harrow, Middlesex, UK

  2. 2

    University of Aberdeen, Cochrane Incontinence Review Group, Foresterhill, Aberdeen, UK

  3. 3

    St Mary's Hospital, The Warrell Unit, Manchester, UK

*Christine C Norton, Physiology Unit, St Mark's Hospital, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK. christine.s.norton@kcl.ac.uk. chris.norton@nwlh.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Faecal incontinence is a particularly embarrassing and distressing condition with significant medical, social and economic implications. Anal sphincter exercises and biofeedback therapy have been used to treat the symptoms of people with faecal incontinence. However, standards of treatment are still lacking and the magnitude of alleged benefits has yet to be established.

Objectives

To determine the effects of biofeedback and/or anal sphincter exercises/pelvic floor muscle training for the treatment of faecal incontinence in adults.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 27 February 2006) and the reference lists of relevant articles.

Selection criteria

All randomised or quasi-randomised trials evaluating biofeedback and/or anal sphincter exercises in adults with faecal incontinence.

Data collection and analysis

Two reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials. A wide range of outcome measures were considered.

Main results

Eleven eligible studies were identified with a total of 564 participants. In all but three trials methodological quality was poor or uncertain. No study reported a major difference in outcome between any method of biofeedback or exercises and any other method, or compared to other conservative management. There are suggestions that rectal volume discrimination training improves continence more than sham training and that anal biofeedback combined with exercises and electrical stimulation provides more short-term benefits than vaginal biofeedback and exercises for women with obstetric-related faecal incontinence. Further conclusions are not warranted from the available data.

Authors' conclusions

The limited number of identified trials together with their methodological weaknesses do not allow a definitive assessment of the possible role of anal sphincter exercises and biofeedback therapy in the management of people with faecal incontinence. We found no evidence of biofeedback or exercises enhancing the outcome of treatment compared to other conservative management methods. While there is a suggestion that some elements of biofeedback therapy and sphincter exercises may have a therapeutic effect, this is not certain. Larger well-designed trials are needed to enable safe conclusions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Exercises of the muscles around the anus (back passage) with or without biofeedback (aids for knowing when the muscles are contracting) for the treatment of faecal incontinence in adults.

Faecal incontinence (inability to control bowel movements or leaking stool) can be a very embarrassing and socially restricting problem. There are many possible causes, including childbirth damage to the muscles which control bowel movements. Exercises to strengthen these muscles and "biofeedback" (used to show people how to use the muscles properly) are often recommended.

The review found that there is not enough evidence from trials to judge whether these treatments are helpful. Exercises and electrical stimulation used in the anus may be more helpful than vaginal exercises for women with faecal incontinence after childbirth.

The 11 trials reviewed were of very limited value because they were generally small, of poor or uncertain quality, and compare different combinations of treatments.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

利用生物回饋訓練和括約肌運動治療成人大便失禁

大便失禁絕對可以說是一個令人困窘和煩惱的議題,而且跟健康,社會以及經濟層面都息息相關。利用括約肌的運動,和生物回饋訓練來治療成人大便失禁已經行之有時。然而,治療的標準仍然缺乏,而且實際使用的效果也尚未確定。

目標

確立生物回饋的訓練,和肛門括約肌/骨盆底肌肉的運動對治療成人大便失禁的效果

搜尋策略

我們回顧了考科藍實證醫學資料庫裡2006年2月27號以前,研究失禁且經過專業臨床試驗的論文,在最後列上相關文章的參考資料

選擇標準

所有被選擇的隨機試驗,都是用來評估生物回饋訓練和肛門括約肌運動的治療,對成人大便失禁的影響

資料收集與分析

兩名回顧者利用標準化的準則來評估各篇研究方法的品質,而其餘兩名回顧者則獨立的從被篩選出的試驗中抽取出數據。治療效果的評估希望是採取多方考量。

主要結論

11個試驗中共有564名的參與者。除了三個試驗外,大多數試驗在經過標準化評估後發現研究品質或方法不良。沒有任何一個試驗指出任何形式的生物回饋訓練,括約肌運動,或是其他治療間有顯著的差異,也沒有這些方法和傳統保守療法間的比較。有建議指出肛門感知辨別訓練對於增加排便控制力比起對照組而言有較大的進步。對那些因生產而大便失禁的婦女來說,肛門的生物回饋合併電刺激及運動訓練,比起陰道生物回饋和運動訓練,更能在短時間內達到效果。進一步的結論並沒有在可取得的數據中被證明。

作者結論

有限的試驗篇數和研究方法的缺陷,使的我們無法可靠的評估肛門括約肌運動及生物回饋的訓練,在大便失禁病人的治療上佔有有怎麼樣的地位。也找不到證據顯示肛門括約肌運動及生物回饋的訓練比起傳統的保守治療能達到更好的效果。有建議指出肛門括約肌運動及生物回饋的訓練可能有某種程度上的效果,但還是不能完全確定。我們需要更大型,設計更完善的試驗來達到一個可以肯定的結果。

翻譯人

本摘要由中國醫藥大學附設醫院張嘉容翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

生物回饋反映出一個人如何正確的使用肌肉,在有或沒有生物回饋輔助下(藉由知道肌肉何時收縮)運動肛門周圍的肌肉可以用來治療大便失禁。大便失禁可以是非常令人困窘甚至影響到社交的問題。大便失禁的原因有很多,例如生產時傷害到控制直腸運動的肌肉。運動訓練這些肌肉的強度和生物回饋訓練是常被建議的治療。這篇回顧文章發現並沒有足夠的證據顯示這些治療方法有效與否。對於產傷失禁的婦女而言,肛門的電刺激和運動可能比陰道的運動來的更有幫助。回顧的這11個試驗大多因為研究數太少,研究品質不良,比較的都是不同療法的併用,能提供的價值非常有限。