Use of biofeedback in treatment of fecal incontinence in patients with meningomyelocele.

Fourteen children (aged 5 to 17 years) with meningomyelocele and significant fecal soiling underwent anorectal manometry using a three-balloon system connected to a physiograph. On the basis of manometric criteria demonstrating some rectal sensation, eight patients were treated with biofeedback conditioning. Patients were taught to contract the external and sphincter or nearby gluteal muscles in response to various volumes of rectal distention. Four of the eight patients who were treated with biofeedback had a good clinical response with disappearance of soiling or a greater than 75% improvement in the frequency of soiling. Follow-up periods ranged from three to 12 months. The minimum criteria for successful treatment appeared to be normal threshold of rectal sensation and ability to contract gluteal or related muscles. Anorectal manometry is a rapid, easily obtained test that can identify those children with meningomyelocele and fecal incontinence who may benefit from biofeedback conditioning. Biofeedback is a simple, safe, and effective technique in the treatment of certain children with fecal soiling due to neurogenic anal sphincter dysfunction.