Anal reeducation for postoperative fecal incontinence in congenital diseases of the rectum and anus.

From October 1993 to March 1996, 14 patients with anorectal disease were referred to an anal reeducation clinic. Initial evaluation allowed the authors to identify three classes of defects: lack of proprioception in the sphincters, use of synergistic muscles (gluteal) to compensate for anal dysfunction, and inversion of command by contraction, rather than relaxation, of abdominal muscles. Patients were treated by electrostimulation through an anal probe as well as biofeedback therapy coupled with home exercises. This therapy resulted in rapid correction of the abnormal motor commands and erroneous use of accessory muscles. All patients became able to isolate their continence muscles with success, with documented increase in strength, rapidity of response, and duration of contraction. The mean Kelly score went from 1.46 (range, 0 to 4.5) to 3.07 (range, 0.5 to 5.5). This physiological improvement also increased patient motivation and discipline toward continence and subsequently their quality of life.