From the 95^th Annual Meeting of the American Society of Colon and Rectal Surgeons

Biofeedback in Colorectal Practice: A Multi-Center, Statewide, 3 Year Experience

A. Ferrara, MD, J.R. Levy, MD, S.W. Larach, MD, M. Kroecker, MD, and P.R. Williamson, MD. Colon and Rectal Clinic of Orlando, Orlando, Florida

Biofeedback treatment is often offered to patients seen in colorectal centers, however standards of treatment are still lacking. A dedicated team approach is desirable but may prove difficult to coordinate.

AIM: To evaluate our 3 year experience of EMG based biofeedback treatment offered within a multi-centered, statewide organization.

METHODS: Between 10/92 and 10/95 188 patients completed a biofeedback treatment program in one of 5 coordinated centers in a 200 mile radius. A unified common database was established and continuously updated. A colorectal surgeon served as statewide director and dedicated teams were established at each location. Each local team included a medical director, a specially trained biofeedback therapist, and has access to a dietitian and a nurse data coordinator. EMG based biofeedback sessions were given weekly and a home trainer program was established.

116 patients with chronic constipation or pelvic floor dysfunction (88F/28M, mean age 73 years) had a mean of 8 weekly sessions (range 2-14). 72 patients with fecal incontinence (43F/29M, mean age 70 years) had a mean of 7 weekly sessions (range 2-11).

RESULTS: 84% of the constipated and 85% of the incontinent patients had significant improvement with biofeedback treatment. Patient compliance and satisfaction were high. Constipated patients increased the mean number of weekly unassisted bowel movements from 0.8 to 6.5 (+662%). Fecal incontinent patients decreased the mean number of weekly gross incontinence episodes from 11.8 to 2 (-500%).

CONCLUSIONS: Biofeedback treatment can be an extremely successful in both incontinent and constipated patients. A large geographical area can be covered with coordinated centers where each dedicated team utilizes a unified treatment protocol and a common database is established.

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