Encopresis, Fecal Incontinence, Fecal Soiling
Conditions
Keywords
Fecal incontinence, Biofeedback, Transcutaneous posterior tibial nerve stimulation, Childern
Brief 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%.
Interventions
DEVICEBiofeedback
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).
DEVICEElectrical stimulation
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.
OTHERTraditional treatment
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.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
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).
Eligibility
Sex/Gender
ALL
Age
5 Years to 15 Years
Healthy volunteers
No
Inclusion criteria
* FecaI incontinence * Normal defecation frequency, * Normal bowel habits and * Normal stool consistency
Exclusion criteria
* Children who are not cooperative, * Children with traumatic sphincter injury, * Children with fecal impaction, * Children with spinal diseases causing incontinence, * Children with anorectal malformation,
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incontinence score using St' Mark's (Vaiszey) | 3 months after intervention | Questionnaire ranging from zero (indicating complete continence) to 24 (indicating total incontinence). |
| incontinence score using St' Mark's (Vaiszey) | 6 months after intervention | Questionnaire ranging from zero (indicating complete continence) to 24 (indicating total incontinence). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| First sensation (volume of the balloon by cm water) | 3 months after intervention | First sensation of the stool in the rectum |
| Resting pressure (mm hg) | 3 months after intervention | Pressure during relaxation of the anal sphincter |
| Intense urge (volume of the balloon by cm water) | 3 months after intervention | The Patent can no longer control the defecation |
| First Urge(volume of the balloon by cm water) | 3 months after intervention | The patient is trying to hold defecation and he can |
| Squeeze pressure (mm hg) | 3 months after intervention | Pressure during contraction of the anal sphincter |
Countries
Egypt
Outcome results
None listed