Fecal Incontinence
Conditions
Keywords
Exercise Therapy, Biofeedback (Psychology), Adult, Fecal Incontinence/*therapy, EMG - Biofeedback, EMG - Triggered Stimulation, Augmented biofeedback
Brief summary
The efficacy of biofeedback and/or low frequency electrical stimulation for the treatment of anal incontinence has not been proven. First, large well-designed clinical trials are missing. Second, only few patients reach therapeutically relevant intensities with low frequency stimulation. In this study, a novel therapeutic concept, termed triple target treatment (3T) was evaluated. 3T combines stimulation with amplitude modulated middle frequency (AM-MF), electromyography (EMG)-triggered stimulation and EMG-biofeedback. 3T was compared with EMG-biofeedback alone after a nine month treatment period. Methods In this parallel-group randomised multicenter study with blinded observer we enrolled 158 patients with anal incontinence. Primary endpoints were changes from baseline to nine months in the Cleveland Clinic Score (CCS) and the St. Mark's score (Vaizey score).
Interventions
In the 3T arm, patients were stimulated with a carrier wave of 25 KHz and biphasic modulations of the pulse train of 40 Hz. Anxious patients trained at first only in the biofeedback mode. The stimulation was introduced after four weeks for these patients. Patients were instructed to carry out the training at home, with an alternating combination in the morning and with EMG-triggered stimulation in the evening, each for 20-minute periods. Apart from this, the protocol of the active treatment group was identical to that of the control group.
DEVICEEMG-biofeedback alone
In the biofeedback arm, patients were instructed to carry out EMG-biofeedback training at home, standing, mornings and evenings, for 20-minute periods. The core of the task was to pull the plug-electrode upward inside the anal channel, like a lift, and to hold it there during varying periods of tension. This can only be done successfully if the perineum rises and at the same time the puborectal muscle is activated. Just squeezing the sphincter muscles does not produce this lifting effect.
Sponsors
University of Giessen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All Patients with fecal incontinence I-III.
Exclusion criteria
* All Patients with CID´s * Definite or possible pregnancy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Cleveland Clinic Incontinence Score (CCS) in its validated German form after nine months, compared to baseline | 9 months after randomization |
| Validated new St. Mark's incontinence score (Vaizey score) in its adapted German form after nine months, compared to baseline. | 9 months after randomization |
Secondary
| Measure | Time frame |
|---|---|
| Quality of life according to the Fecal Incontinence Quality of Life Scale (FIQoL) in its validated German form after nine months compared to baseline, as well as between the two treatment groups over the course of time as compared to baseline | 9 months after randomization |
| CCS score after six or three months, compared to baseline | 3 months, 6 months after randomization |
| Use of stool regulating medication. Specifically, if biofeedback and 3T increase continence, the use of any stool regulating medication (Fleawort seeds, Loperamide, teas, etc.) should decrease in the course of the trial. | 9 months after randomization |
| Track record of the treatment: 1. Continent, 2. Grade improvement (grade II or III to grade I), 3. Frequency improvement: (same grade, >= 2 points improvement in CCS), 4. no improvement, or deterioration, 5. early dropouts. | 9 months after randomization |
| Adapted Vaizey score after six or three months compared to baseline | 3 months, 6 months |
Countries
Germany
Outcome results
None listed