Henri Damon1, Laurent Siproudhis2, Jean-Luc Faucheron3, Thierry Piche4, Laurent Abramowitz5, Marianne Eléouet6, Isabelle Etienney7, Philippe Godeberge8, Guy Valancogne9, Angélique Denis10, François Mion11, Anne-Marie Schott12. 1. Hospices Civils de Lyon, Digestive Physiology, Lyon, France. 2. CHU Rennes, Gastroenterology, and Rennes University, France. Electronic address: laurent.siproudhis@chu-rennes.fr. 3. CHU Grenoble, Digestive Surgery, and Grenoble University, France. 4. CHU Nice, Gastroenterology, France. 5. AP-HP, Bichat Hospital, Gastroenterology, Paris, France. 6. CHU Rennes, Gastroenterology, and Rennes University, France. 7. Diaconnesses Hospital, Proctology, Paris, France. 8. Institut Mutualiste Montsouris, Gastroenterology, Paris, France. 9. Centre Tete d'Or, Physiotherapy, Lyon, France. 10. Hospices Civils de Lyon, Epidemiology Unit, Lyon, France. 11. Hospices Civils de Lyon, Digestive Physiology, Lyon, France; University Lyon 1, France. Electronic address: francois.mion@chu-lyon.fr. 12. Hospices Civils de Lyon, Epidemiology Unit, Lyon, France; University Lyon 1, France.
Abstract
BACKGROUND: Anal incontinence is a frequent complaint that profoundly affects quality of life. Our aim was to determine whether perineal retraining gives additional benefits to standard medical treatment. METHODS:Patients with anal incontinence and a Wexner score >4 were randomly assigned to standard conservative treatment (control) or perineal retraining, including biofeedback, in addition to standard treatments (biofeedback). Diaries, self-administered questionnaires and satisfaction scores quantified the benefits. Self-evaluated improvement was the primary outcome measure. A score ≥3 (in an improvement scale from -5 to +5) defined success. RESULTS: Overall, 157 patients were included; 80 in the control group (75% females, mean age 60.1 ± 13.2 years) and 77 in the biofeedback group (79% females, mean age 61.9 ± 10.2 years). After a 4-month follow-up, the success rate was significantly higher in the biofeedback group (57% versus 37%; p<0.021). In the biofeedback group, daily stool frequency, leakage, and faecal urgency significantly decreased, and daily non-urgent perception of stool increased. Conversely, symptomatic scores and quality of life scales did not significantly differ between groups. In a multivariate model, the adjusted odds ratio showed that perineal retraining was significantly associated with a higher chance of self-rated improvement (adjusted Odd Ratio [95%CI]: 2.34 [1.14-4.80]; p=0.021). CONCLUSIONS:Perineal retraining offers a moderate but significant benefit for patients suffering from anal incontinence.
RCT Entities:
BACKGROUND:Anal incontinence is a frequent complaint that profoundly affects quality of life. Our aim was to determine whether perineal retraining gives additional benefits to standard medical treatment. METHODS:Patients with anal incontinence and a Wexner score >4 were randomly assigned to standard conservative treatment (control) or perineal retraining, including biofeedback, in addition to standard treatments (biofeedback). Diaries, self-administered questionnaires and satisfaction scores quantified the benefits. Self-evaluated improvement was the primary outcome measure. A score ≥3 (in an improvement scale from -5 to +5) defined success. RESULTS: Overall, 157 patients were included; 80 in the control group (75% females, mean age 60.1 ± 13.2 years) and 77 in the biofeedback group (79% females, mean age 61.9 ± 10.2 years). After a 4-month follow-up, the success rate was significantly higher in the biofeedback group (57% versus 37%; p<0.021). In the biofeedback group, daily stool frequency, leakage, and faecal urgency significantly decreased, and daily non-urgent perception of stool increased. Conversely, symptomatic scores and quality of life scales did not significantly differ between groups. In a multivariate model, the adjusted odds ratio showed that perineal retraining was significantly associated with a higher chance of self-rated improvement (adjusted Odd Ratio [95%CI]: 2.34 [1.14-4.80]; p=0.021). CONCLUSIONS: Perineal retraining offers a moderate but significant benefit for patients suffering from anal incontinence.