ON FECAL INCONTINENCE:
"Biofeedback has become an accepted treatment alternative for anal incontinence96-101."
[Source: S. Wexner. Fundamentals of Anorectal Surgery, (New York: McGraw-Hill, 1992), p. 114. ]
"Biofeedback therapy for fecal incontinence was effective in treating children with surgical repair of imperforate anus."
[Source: M. L. Allen. "Biofeedback for Fecally Incontinent Children With Repaired Imperforate Anus." Practical Gastroenterology, March, 1990, 14:3, p. 53-62.]
"Biofeedback training appears to be of specific value in the treatment of fecal incontinence in the elderly. ... Sphincter exercises without biofeedback training were not effective. ... Biofeedback was also cost-effective."
[Source: W.E. Whitehead, K.L. Burgio, B.T. Engel. "Biofeedback Treatment of Fecal Incontinence in Geriatric Patients" J Am Geriatrics Soc, May, 1985, 33:5, p. 320-325]
"Biofeedback training of the external anal sphincter provides a simple nonmedical/nonsurgical approach to treatment."
[Source: W.C. Orr. "Fecal Incontinence in the Elderly", Geriatric Medicine Today, May, 1988, 7:5, p. 126]
"Patients whose incontinence is due to a wide variety of causes have benefited from biofeedback training. Biofeedback training is also appropriate for patients who remain incontinent after surgical treatment."
[Source: R.D. Madoff, J.G. Williams, P.F. Causha. "Current Concepts: Fecal Incontinence" New England Journal of Medicine, April, 1992, 326:15, p. 1002-1007]
ON EMG VS. MANOMETRICS & PSEUDO-KEGELS:
"Intra-anal EMG sensor-type biofeedback may be more valuable than manometric-based training or simple Kegel exercises."
[Source: S. Wexner. Fundamentals of Anorectal Surgery, (New York: McGraw-Hill, 1992), p. 114.]
"...there are many advantages to the perineometer and electromyograph when it is compared to the balloon and polygraph system. ... It appears to be a reasonable assumption, therefore, that children will learn the appropriate response more quickly with the perineometer than with the polygraph."
[Source: W.P. Lowery, W.E. Whitehead, L. Mellibrunda, M. Cataldo. "Therapist Training Manual: Biofeedback Treatment of Fecal Incontinence Secondary to Meningomyelocele" (Baltimore: J.F. Kennedy Institute), n.d.]
ON LIMITATIONS OF E-STIM FOR PAIN:
"EGS may benefit some patients (43%). ...57% of patients in this study received no benefit after a mean follow-up time of 28 mos."
[Source: T.L. Hull, J.W. Milson, J.M. Church, J.R. Oakley, I.C. Lavery, V.W. Fazio, Cleveland, OH. "Electrogalvanic Stimulation for Levator Syndrome: How Effective Is It In The Long Term?" [Poster, Am Soc Colon Rect Surg, June, 1992] (52 patients, Sohn's High voltage EGS protocol.)]
ON EMG BIOFEEDBACK FOR NRPRS:
"Biofeedback management is an attractive alternative because of its relatively small expense and the absence of any known morbidity. This technique of training the mind to control somatic functions has been used successfully for treatment of other conditions, such as headaches, chronic pain, and fecal incontinence.13-15"
[Source: J.J. Nogueras & S.D. Wexner. "Biofeedback for Nonrelaxing Puborectalis Syndrome" Seminars in Colon & Rectal Surgery, 3 (2) June, 1992, p. 120-124)]
"EMG-based biofeedback appears to have both the highest success rate and the lowest morbidity. Moreover, the present report has documented that this success can be achieved after inexpensive outpatient therapy. ... EMG-based biofeedback is the therapy of choice for patients with PPC."
[Source: S.D. Wexner, J.D. Cheape, J.M.N. Jorge, S. Heyman, D.G. Jagelman. "Prospective Assessment of Biofeedback for the Treatment of Paradoxical Puborectalis Contraction." Dis Colon Rectum, February, 1992, 35:2, p. 145-150.]
"As anismus subjects are unaware of the incoordination of the pelvic floor, biofeedback [using a surface anal plug] offers a simple and minimally invasive technique for relearning how to suppress the non-relaxation of the pelvic floor."
[Source: B.W. Kawimbe, M. Papachrysostomou, N.R. Binne, N. Clare, A.N. Smith. "Outlet obstruction constipation (anismus) managed by biofeedback." Gut, 1991, 32: 1175-1179.]
ON ADVANTAGES OF THE LONGITUDINAL ELECTRODE:
"When the non-invasive longitudinal electrode was compared to invasive fine wire stainless steel electrodes, a correlation was found for external anal sphincter resting EMG (r=0.99, p<0.01), voluntary squeeze EMG (r=0.99, p<0.001) and strain EMG (r=0.91, p<0.01). The longitudinal anal plug electrode thus facilitates surface acquisition of EMG activity."
[Source: N.R. Binnie, B.M. Kawimbe, M. Papachrysostomou, N. Clare and A.N. Smith. "The Importance of the orientation of the electrode plates in recording the external anal sphincter EMG by non-invasive anal plug electrodes." Int J Colorectal Dis, 1991, 6:5, 8-11.]
The PerryAnal™ brand internal-surface EMG sensor is patented - U.S. No. 4,396,019; U.K. No. 2,119,516; Canada No. 1,191,207; France No. 2,507,076; Germany 32 18 938; and other patents pending.
©1992 John D. Perry, Ph.D., F.A.A.C.S. & Lesley Talcott May, M.S., R.N.