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

Electromyographic Assessment of Biofeedback Training for Fecal Incontinence and Chronic Constipation

N.J. Espat, MD; A. Ferrara, MD; S.W. Larach, MD; and P.R. Williamson, MD Colon and Rectal Clinic of Orlando, Orlando, Florida

Biofeedback Training (BFT) is an effective modality for the treatment of chronic constipation (CC) and fecal incontinence (FI). In general, patients express satisfaction and perceive functional improvement following BFT; however, quantifying these observations has been difficult.

AIM: To evaluate the role of non-invasive intra-anal electromyography (EMG) as an indicator for benefit from BFT.

METHODS: 55 patients who underwent computerized EMG based biofeedback treatment at our institution between July 1993 and July 1995 were identified. Non-invasive EMG testing was performed before, during (weekly) and at completion of training. Mean number of weekly sessions was 7 (range 5-11). Short term and ten second contractions (amplitude/microV) as well as sustained contractions (endurance/seconds) were analyzed for statistical significance. Patients were divided into groups; 30 CC patients, mean age 65.3 (range 33-86) composed of 24 females and 6 males, and 25 FI patients, mean age 66 (range 34-85) composed of 13 females and 12 males.

RESULTS: As shown in the following table, statistically significant improvement in endurance following biofeedback training was noted in both the CC and FI groups.

Group: Mean S.E.M.
CC B BFT (Before) 6.39 seconds 0.66
CC A BFT (After) 10.77* 0.35
FI B BFT (Before) 7.50 1.3
FI A BFT (After) 13.06** 0.58

*p<.002, **p<.035 (paired T-test)

53/55 patients subjectively expressed 50-100% improvement after BFT. 46/55 patients individually demonstrated improved endurance.

CONCLUSIONS: Sphincter endurance significantly improves following BFT in both CC and FI patients. These data suggest that intra-anal EMG-measured endurance may be a useful tool in assessing benefit from biofeedback training in these patients.

© 1996 ASCRS

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