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Zhang T, Huang Z, Zou Y, Zhao J, Ke Y. A Prediction Model of Defecation Based on BP Neural Network and Bowel Sound Signal Features. SENSORS (BASEL, SWITZERLAND) 2022; 22:7084. [PMID: 36146430 PMCID: PMC9501137 DOI: 10.3390/s22187084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Incontinence and its complications pose great difficulties in the care of the disabled. Currently, invasive incontinence monitoring methods are too invasive, expensive, and bulky to be widely used. Compared with previous methods, bowel sound monitoring is the most commonly used non-invasive monitoring method for intestinal diseases and may even provide clinical support for doctors. (2) Methods: This paper proposes a method based on the features of bowel sound signals, which uses a BP classification neural network to predict bowel defecation and realizes a non-invasive collection of physiological signals. Firstly, according to the physiological function of human defecation, bowel sound signals were selected for monitoring and analysis before defecation, and a portable non-invasive bowel sound collection system was built. Then, the detector algorithm based on iterative kurtosis and the signal processing method based on Kalman filter was used to process the signal to remove the aliasing noise in the bowel sound signal, and feature extraction was carried out in the time domain, frequency domain, and time-frequency domain. Finally, BP neural network was selected to build a classification training method for the features of bowel sound signals. (3) Results: Experimental results based on real data sets show that the proposed method can converge to a stable state and achieve a prediction accuracy of 88.71% in 232 records, which is better than other classification methods. (4) Conclusions: The result indicates that the proposed method could provide a high-precision defecation prediction result for patients with fecal incontinence, so as to prepare for defecation in advance.
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Affiliation(s)
- Tie Zhang
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou 510641, China
| | - Zequan Huang
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou 510641, China
| | - Yanbiao Zou
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou 510641, China
| | - Jun Zhao
- China Rehabilitation Research Center, Beijing 100000, China
| | - Yuwei Ke
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou 510641, China
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Mazor Y, Prott G, Jones M, Ejova A, Kellow J, Malcom A. Factors Associated With Response to Anorectal Biofeedback Therapy in Patients With Fecal Incontinence. Clin Gastroenterol Hepatol 2021; 19:492-502.e5. [PMID: 32251788 DOI: 10.1016/j.cgh.2020.03.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/06/2020] [Accepted: 03/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Anorectal biofeedback (BF) is commonly used to treat patients with fecal incontinence (FI), but demand usually exceeds availability. It is therefore important to identify patients most likely to respond to BF treatment. We aimed to identify pre-treatment clinical or physiologic factors that might be used to predict completion and success of BF in women with FI. METHODS We analyzed data from 400 women with FI (mean age, 61 ± 14 y) undergoing instrumental BF in a tertiary care setting from 2003 through 2016. All patients completed questionnaires before BF, including Rome and the hospital anxiety and depression scale questionnaires. Histories of medication use, surgery, medical conditions, and bowel pattern were recorded, urge was assessed, and patients kept stool diaries. Before and after treatment (6 weekly sessions with a gastroenterologist-supervised nurse specialist, 4 involving instrumented anorectal biofeedback), patients were examined by a physician and fecal incontinence severity index and visual analogue scale scores were recorded. The main outcome measure was response to therapy, defined as improvement of 50% or more in weekly FI episodes at the end of BF compared with before BF. RESULTS The BF treatment was completed by 363 women (91%); of these, 62 had low baseline symptom frequency (no FI episodes in the 2 weeks before BF). Younger age was associated with failure to complete treatment. Of the 301 patients remaining, 202 patients (67%) had a response to therapy; among these women, urge FI was associated with response at end of BF, but not at follow up (6 months after therapy). Baseline severity of symptom scores and quality of life measures were associated with greater improvement in the same variable at the end of BF and after 6 months. Patients with low baseline symptom frequency improved in all secondary outcome measures, similar to patients with higher baseline symptom frequency. CONCLUSIONS In an analysis of 363 women with FI, approximately two-thirds had a response to BF treatment. Urge FI was the only baseline variable associated with response. Baseline severity of symptoms and quality of life measures were associated with greater improvement in the same variable, but not overall response. It is therefore a challenge to select treatment for patients with FI.
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Affiliation(s)
- Yoav Mazor
- Department of Gastroenterology, Royal North Shore Hospital, St Leonards, NSW; University of Sydney, Sydney, NSW.
| | - Gillian Prott
- Department of Gastroenterology, Royal North Shore Hospital, St Leonards, NSW
| | - Michael Jones
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Anastasia Ejova
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - John Kellow
- Department of Gastroenterology, Royal North Shore Hospital, St Leonards, NSW; University of Sydney, Sydney, NSW
| | - Allison Malcom
- Department of Gastroenterology, Royal North Shore Hospital, St Leonards, NSW; University of Sydney, Sydney, NSW
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Khera AJ, Chase JW, Salzberg M, Thompson AJV, Kamm MA. Gut-Directed Pelvic Floor Behavioral Treatment for Fecal Incontinence and Constipation in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:620-626. [PMID: 30452638 DOI: 10.1093/ibd/izy344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) often experience functional bowel symptoms despite achieving disease remission. Although behavioral treatment (bowel and pelvic floor muscle retraining) is effective for managing constipation or fecal incontinence in non-IBD patients, there is limited evidence for its efficacy in patients with quiescent inflammatory bowel disease. The aim of this study was to evaluate the outcome of gut-directed behavioral treatment, including pelvic floor muscle training, for symptoms of constipation or fecal incontinence in patients with IBD in disease remission. METHODS The outcome of consecutive patients with IBD in remission and symptoms of constipation or fecal incontinence was evaluated. Patients referred to a multidisciplinary gastroenterology clinic underwent gut-directed behavioral treatment, including pelvic floor muscle training. The primary outcome was patient-reported rating of change in symptoms on a 7-point Likert scale at the completion of treatment. RESULTS Forty IBD patients (median age, 35 years; 80% female; 24 Crohn's disease [CD], 12 ulcerative colitis [UC], 4 UC with ileoanal pouch) with ongoing symptoms of constipation (55%) or fecal incontinence (45%), despite drug therapy, were included. The median symptom duration at referral was 2 years. Thirty-five (87%) completed treatment with a median of 2 sessions. Improvement of "6 = much better" or "7 = very much better" was reported by 77% (17/22) with fecal incontinence and 83% (15/18) with constipation. Improvement occurred irrespective of IBD diagnosis, previous perianal fistulae, colorectal surgery, presence of an ileoanal pouch, or past obstetric trauma. CONCLUSIONS Behavioral treatment effectively improves functional gut symptoms in a large majority of patients who are in IBD disease remission and who have not responded to drug therapy. 10.1093/ibd/izy344_video1 izy344.video1 5968879349001.
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Affiliation(s)
- Angela J Khera
- Department of Gastroenterology, St Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
| | - Janet W Chase
- Department of Gastroenterology, St Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
| | - Michael Salzberg
- Department of Gastroenterology, St Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
| | - Alexander J V Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
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Wiegersma M, Panman CMCR, Hesselink LC, Malmberg AGA, Berger MY, Kollen BJ, Dekker JH. Predictors of Success for Pelvic Floor Muscle Training in Pelvic Organ Prolapse. Phys Ther 2019; 99:109-117. [PMID: 30329105 DOI: 10.1093/ptj/pzy114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 06/18/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although the effectiveness of pelvic floor muscle training in women with prolapse has been demonstrated in several studies, there seem to be subgroups of responders and nonresponders. OBJECTIVE The objective of this study was to identify factors that predict treatment success in women receiving pelvic floor muscle training for prolapse. DESIGN The design was a secondary analysis of data from 2 randomized controlled trials comparing conservative prolapse treatments. METHODS After 12 months, 172 women subjectively assessed treatment success ("better") or failure ("the same" or "worse"). Potential predictors were identified by a literature search and by consultation with experts in the field of urogynecology and pelvic floor muscle training. The relationship between potential predictors and treatment success was explored using logistic regression analysis. RESULTS Treatment was successful in 94 women (55%) and unsuccessful in 78 women (45%). The presence of ≥1 indicators of obstetric trauma (eg, high birth weight, episiotomy, perineal laceration during vaginal delivery, forceps delivery, or vacuum extraction) (odds ratio = 4.4; 95% CI = 1.6-12.0) and younger age (odds ratio = 0.94 per year; 95% CI = 0.9-1.0) independently predicted treatment success. The area under the receiver operating characteristic curve for the final model was 0.65 (95% CI = 0.57-0.74), and the model explained 11.7% of the variance. LIMITATIONS Although attempts were made to include all relevant predictors, the selection or operationalization of variables could have been incomplete or insufficient. CONCLUSIONS Identifying women who have prolapse and are likely to benefit most from pelvic floor muscle training is of great importance to clinical practice. In this study, 2 factors that independently predicted favorable outcomes were identified with this management approach. However, further research is needed to identify other predictive factors and to validate a new model in another population.
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Affiliation(s)
- Marian Wiegersma
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | | | | | - Janny H Dekker
- Department of General Practice, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, Postbus 196/FA21, Groningen, the Netherlands
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Lacima G, Pera M, González-Argenté X, Torrents A, Valls-Solé J, Espuña-Pons M. Is electromyography a predictive test of patient response to biofeedback in the treatment of fecal incontinence? Neurourol Urodyn 2015; 35:390-4. [PMID: 25597297 DOI: 10.1002/nau.22715] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 10/27/2014] [Indexed: 11/11/2022]
Abstract
AIM Biofeedback is effective in more than 70% of patients with fecal incontinence. However, reliable predictors of successful treatment have not been identified. The aim was to identify clinical variables and diagnostic tests, particularly electromyography, that could predict a successful outcome. METHODS We included 135 consecutive women with fecal incontinence treated with biofeedback. Clinical evaluation, manometry, ultrasonography, electromyography, and pudendal nerve terminal motor latency were performed before therapy. Treatment outcome was assessed using a symptoms diary, Wexner incontinence score and the patient's subjective perception. RESULTS According to the symptoms diaries, 106 (78.5%) women had a good clinical result and 29 (21.5%) had a poor result. There were no differences in age, severity and type of fecal incontinence. Maximum resting pressure (39.3 ± 19.1 mmHg vs. 33.7 ± 20.2 mmHg; P = 0.156) and maximum squeeze pressure (91.8 ± 33.2 mmHg vs. 79.8 ± 31.2 mmHg; P = 0.127) were higher in patients having good clinical outcome although the difference was not significant. There were no differences in the presence of sphincter defects or abnormalities in electromyographic recordings. Logistic regression analysis found no independent predictive factor for good clinical outcome. CONCLUSIONS Biofeedback is effective in more than 75% of patients with fecal incontinence. Clinical characteristics of patients and results of baseline tests have no predictive value of response to therapy. Specifically, we found no association between severity of electromyographic deficit and clinical response.
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Affiliation(s)
- Gloria Lacima
- Gastrointestinal Surgery Department, Digestive and Metabolic Diseases Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain
| | - Miguel Pera
- Section of Colon and Rectal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute (IMIM), Hospital del Mar, Barcelona, Catalonia, Spain
| | - Xavier González-Argenté
- Gastrointestinal Surgery Department, Digestive and Metabolic Diseases Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain
| | - Abiguei Torrents
- Biostatistics and data Management Platform, Hospital Clínic. IDIBAPS, Barcelona, Catalonia, Spain
| | - Josep Valls-Solé
- Neurology Deparment, Hospital Clínic. IDIBAPS, Barcelona, Catalonia, Spain
| | - Montserrat Espuña-Pons
- Urogynecology Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic, Barcelona, Catalonia, Spain
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Damon H, Siproudhis L, Faucheron JL, Piche T, Abramowitz L, Eléouet M, Etienney I, Godeberge P, Valancogne G, Denis A, Mion F, Schott AM. Perineal retraining improves conservative treatment for faecal incontinence: a multicentre randomized study. Dig Liver Dis 2014; 46:237-42. [PMID: 24444704 DOI: 10.1016/j.dld.2013.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/02/2013] [Accepted: 11/01/2013] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Henri Damon
- Hospices Civils de Lyon, Digestive Physiology, Lyon, France
| | | | | | | | | | | | | | | | | | | | - François Mion
- Hospices Civils de Lyon, Digestive Physiology, Lyon, France; University Lyon 1, France.
| | - Anne-Marie Schott
- Hospices Civils de Lyon, Epidemiology Unit, Lyon, France; University Lyon 1, France
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Bols E, Hendriks E, de Bie R, Baeten C, Berghmans B. Predictors of a favorable outcome of physiotherapy in fecal incontinence: Secondary analysis of a randomized trial. Neurourol Urodyn 2012; 31:1156-60. [DOI: 10.1002/nau.21236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/06/2011] [Indexed: 12/12/2022]
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Abstract
Fecal incontinence is a significant health problem that affects quality of life. Continence may often be improved with changes in diet with or without pharmacologic treatment to optimize the consistency of stool. Biofeedback is a multifaceted therapeutic approach that helps an individual improve his or her sensitivity to rectal distention and respond with appropriate voluntary sphincter control. One or more of these techniques can be used in conjunction with education and supportive counseling to optimize an individual's continence.
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Affiliation(s)
- Amy L Halverson
- Feinberg School of Medicine, Division of Surgical Oncology, Northwestern University, Chicago, Illinois 60611, USA.
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Raza N, Bielefeldt K. Discriminative value of anorectal manometry in clinical practice. Dig Dis Sci 2009; 54:2503-11. [PMID: 19093206 DOI: 10.1007/s10620-008-0631-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 11/12/2008] [Indexed: 12/13/2022]
Abstract
Guidelines recommend anorectal manometry in patients with fecal incontinence and chronic constipation. However, limited evidence supports the utility of manometric testing. We retrospectively reviewed tracings obtained between November 2005 and May 2008. A total of 298 patients (86% women; average age 52 years) were included. The main indications were incontinence (51%) and constipation (42%). Patients suffering from incontinence were older and had lower resting and squeeze pressure compared to continent patients. However, the discriminative power of manometric pressure data was poor, with low sensitivity and specificity. An abnormal straining pattern suggesting dyssynergic defecation was seen in 43% of constipated patients compared to 13% of patients with fecal incontinence. A concordance between manometric patterns and the balloon expulsion test was seen in 72%. The low sensitivity and specificity of manometric parameters does not support the routine use of anorectal manometry in patients with defecation disorders.
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Affiliation(s)
- Naeem Raza
- Division of Gastroenterology, University of Pittsburgh, Pittsburgh, PA 15213, USA
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10
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Can the outcome of pelvic-floor rehabilitation in patients with fecal incontinence be predicted? Int J Colorectal Dis 2008; 23:503-11. [PMID: 18228027 PMCID: PMC2668622 DOI: 10.1007/s00384-008-0438-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2008] [Indexed: 02/04/2023]
Abstract
PURPOSE Pelvic-floor rehabilitation does not provide the same degree of relief in all fecal incontinent patients. We aimed at studying prospectively the ability of tests to predict the outcome of pelvic-floor rehabilitation in patients with fecal incontinence. MATERIALS AND METHODS Two hundred fifty consecutive patients (228 women) underwent medical history and a standardized series of tests, including physical examination, anal manometry, pudendal nerve latency testing, anal sensitivity testing, rectal capacity measurement, defecography, endoanal sonography, and endoanal magnetic resonance imaging. Subsequently, patients were referred for pelvic-floor rehabilitation. Outcome of pelvic-floor rehabilitation was quantified by the Vaizey incontinence score. Linear regression analyses were used to identify candidate predictors and to construct a multivariable prediction model for the posttreatment Vaizey score. RESULTS After pelvic-floor rehabilitation, the mean baseline Vaizey score (18, SD+/-3) was reduced with 3.2 points (p<0.001). In addition to the baseline Vaizey score, three elements from medical history were significantly associated with the posttreatment Vaizey score (presence of passive incontinence, thin stool consistency, primary repair of a rupture after vaginal delivery at childbed) (R2, 0.18). The predictive value was significantly but marginally improved by adding the following test results: perineal and/or perianal scar tissue (physical examination), and maximal squeeze pressure (anal manometry; R2, 0.20; p=0.05). CONCLUSION Additional tests have a limited role in predicting success of pelvic-floor rehabilitation in patients with fecal incontinence.
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Tjandra JJ, Dykes SL, Kumar RR, Ellis CN, Gregorcyk SG, Hyman NH, Buie WD. Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum 2007; 50:1497-507. [PMID: 17674106 DOI: 10.1007/s10350-007-9001-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Joe J Tjandra
- Fletcher Allen Health Care, 111 Colchester Avenue, Fletcher 301, Burlington, Vermont 05401, USA
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12
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Dobben AC, Terra MP, Deutekom M, Gerhards MF, Bijnen AB, Felt-Bersma RJF, Janssen LWM, Bossuyt PMM, Stoker J. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis 2007; 22:783-90. [PMID: 17096089 DOI: 10.1007/s00384-006-0217-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anal inspection and digital rectal examination are routinely performed in fecal incontinent patients but it is not clear to what extent they contribute to the diagnostic work-up. We examined if and how findings of anal inspection and rectal examination are associated with anorectal function tests and endoanal ultrasonography. METHODS A cohort of fecal incontinent patients (n=312, 90% females; mean age 59) prospectively underwent anal inspection and rectal examination. Findings were compared with results of anorectal function tests and endoanal ultrasonography. RESULTS Absent, decreased and normal resting and squeeze pressures at rectal examination correlated to some extent with mean (+/-SD) manometric findings: mean resting pressure 41.3 (+/-20), 43.8 (+/-20) and 61.6 (+/-23) Hg (p<0.001); incremental squeeze pressure 20.6 (+/-20), 38.4 (+/-31) and 62.4 (+/-34) Hg (p<0.001). External anal sphincter defects at rectal examination were confirmed with endoanal ultrasonography for defects <90 degrees in 36% (37/103); for defects between 90-150 degrees in 61% (20/33); for defects between 150-270 degrees in 100% (6/6). Patients with anal scar tissue at anal inspection had lower incremental squeeze pressures (p=0.04); patients with a gaping anus had lower resting pressures (p=0.013) at anorectal manometry. All other findings were not related to any anorectal function test or endoanal ultrasonography. CONCLUSIONS Anal inspection and digital rectal examination can give accurate information about internal and external anal sphincter function but are inaccurate for determining external anal sphincter defects <90 degrees. Therefore, a sufficient diagnostic work-up should comprise at least rectal examination, anal inspection and endoanal ultrasonography.
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Affiliation(s)
- Annette C Dobben
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Byrne CM, Solomon MJ, Young JM, Rex J, Merlino CL. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum 2007; 50:417-27. [PMID: 17476558 DOI: 10.1007/s10350-006-0846-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Biofeedback is well established as a treatment for fecal incontinence but little is known about factors that may be associated with its effectiveness. This study assessed short-term outcomes, predictors of patients who completed treatment, and predictors of treatment success. METHODS This study was a retrospective review of consecutive patients treated with biofeedback at a tertiary referral colorectal clinic during ten years. Clinical, physiologic, and quality of life measures were collected prospectively at the time of treatment. Regression analysis was performed. RESULTS Of 513 patients, 385 (75 percent) completed the treatment program. Each outcome was improved for more than 70 percent of patients. Incontinence scores decreased by 32 percent (from 7.5 to 5.2 of 13), patient assessment of continence increased by 40 percent (from 5.3 to 3.2 of 10), quality of life improved by 89 percent (from 0.34 to 0.67 of 1.0), and maximum anal sphincter pressure increased by a mean 12 mmHg (14 percent; from 90 to 102 mmHg). Patients who did not complete treatment were younger, were more likely to be male, and had less severe incontinence. Treatment success was predicted by completion of all treatment sessions (odds ratio, 10.34; 95 percent confidence interval, 4.46-24.19), female gender (odds ratio, 4.11; 95 percent confidence interval, 1.04-7.5), older age (odds ratio, 1.02 per year; 95 percent confidence interval, 1-1.04), and more severe incontinence before treatment (odds ratio, 1.19 per unit increase in St. Mark's score; 95 percent confidence interval, 1.05-1.34). CONCLUSIONS More than 70 percent of patients in this large series demonstrated improved short-term outcomes. Treatment success was more likely in those who completed six training sessions, were female, older, or had more severe incontinence. Patients were less likely to complete treatment if they were male, younger, or had milder incontinence.
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Affiliation(s)
- Christopher M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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Terra MP, Beets-Tan RGH, van der Hulst VPM, Deutekom M, Dijkgraaf MGW, Bossuyt PMM, Dobben AC, Baeten CGMI, Stoker J. MRI in evaluating atrophy of the external anal sphincter in patients with fecal incontinence. AJR Am J Roentgenol 2006; 187:991-9. [PMID: 16985148 DOI: 10.2214/ajr.05.0386] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE External anal sphincter atrophy seen at endoanal MRI may predict poor outcome of surgical anal sphincter repair for an external anal sphincter defect. The purposes of this study were to compare external phased-array MRI to endoanal MRI for depicting external anal sphincter atrophy in patients with fecal incontinence and to evaluate observer reproducibility in detecting external anal sphincter atrophy with these techniques. SUBJECTS AND METHODS Thirty patients with fecal incontinence (23 women, seven men; mean age, 58.7 years; age range, 37-78 years) underwent both endoanal and external phased-array MRI. Images were evaluated for external anal sphincter atrophy by three radiologists. Measures of differences and agreement between both MRI techniques and of interobserver and intraobserver agreement of both techniques were calculated. RESULTS The MRI techniques did not significantly differ in their ability to depict external anal sphincter atrophy (p = 0.63) with good agreement (kappa = 0.72). Interobserver agreement was moderate (kappa = 0.53-0.56) for endoanal MRI and moderate to good (kappa = 0.55-0.8) for external phased-array MRI. Intraobserver agreement was moderate to very good (kappa = 0.57-0.86) for endoanal MRI and fair to very good (kappa = 0.31-0.86) for external phased-array MRI. CONCLUSION External phased-array MRI is comparable to endoanal MRI in depicting external anal sphincter atrophy and, thereby, in selecting patients for anal sphincter repair. Because results among interpreters varied considerably depending on the experience level, both techniques can be recommended in the diagnostic workup of fecal incontinence only if sufficient experience is available.
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Affiliation(s)
- Maaike P Terra
- Department of Radiology, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands 1105 AZ.
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15
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Dobben AC, Terra MP, Berghmans B, Deutekom M, Boeckxstaens GEE, Janssen LWM, Bossuyt PMM, Stoker J. Functional changes after physiotherapy in fecal incontinence. Int J Colorectal Dis 2006; 21:515-21. [PMID: 16244864 DOI: 10.1007/s00384-005-0049-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND Physiotherapy is a common treatment option in patients with fecal incontinence. Although physiotherapy may result in relief of symptoms, to what extent improvement is associated with changes in anorectal function is still unclear. AIM The aim of the present study was to investigate prospectively how anorectal function changes with physiotherapy and whether these changes are related to changes in fecal incontinence score. METHODS Consenting consecutive patients (n=266) with fecal incontinence (91% women; mean age, 59 years) underwent anorectal manometry, anal and rectal mucosal sensitivity measurements, and rectal capacity measurement at baseline and after nine sessions of standardized pelvic floor physiotherapy. These findings were compared with changes in Vaizey incontinence score. RESULTS On follow-up 3 months after physiotherapy, squeeze pressure (p=0.028), as well as urge sensation threshold (p=0.046) and maximum tolerable volume (p=0.018), had increased significantly. The extent of improvement was not related to age, duration of fecal incontinence, menopause, and endosonography findings. All other anorectal functions did not change. An improvement in the Vaizey score was moderately correlated with an increase in incremental squeeze pressure (r=0.14, p=0.04) and a decrease in anal mucosal sensitivity threshold (r=0.20, p=0.01). CONCLUSIONS Physiotherapy improves squeeze pressure, urge sensation, and maximum tolerable volume. However, improved anorectal function does not always result in a decrease in fecal incontinence complaints.
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Affiliation(s)
- Annette C Dobben
- Department of Radiology, Academic Medical Center, G1-228, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Deutekom M, Terra MP, Dijkgraaf MGW, Dobben AC, Stoker J, Boeckxstaens GE, Bossuyt PMM. Patients' perception of tests in the assessment of faecal incontinence. Br J Radiol 2006; 79:94-100. [PMID: 16489189 DOI: 10.1259/bjr/63269033] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The objective of this study was to evaluate patient perception of endoanal MRI compared with defecography and anorectal functional testing in the workup of patients with faecal incontinence. Consenting consecutive patients underwent a standard testing protocol consisting of endoanal MRI, defecography and anorectal function combination. Patient experience was evaluated with a self-administered questionnaire, addressing anxiety, embarrassment, pain and discomfort, each measured on a 1 (none) to 5 (extreme) point-scale. Patients were also asked to rank the three tests from least to most inconvenient. Statistical analysis was performed with parametric tests. Data from 211 patients (23 men; mean age 59 years (SD+/-12)) were available. MRI had the lowest average score for embarrassment and discomfort (1.6) and defecography the highest (1.9 and 2.0, respectively) (p<0.0001, tested with general linear model for related samples). The average pain score was lowest for MRI (1.4) and highest for the anorectal function combination (1.7) (p<0.0001). Level of anxiety was highest for MRI (1.6 versus 1.4; p = 0.03). MRI was scored as least inconvenient by 69% of patients. Endoanal MRI was scored as least inconvenient. However, the differences in patient burden between the three diagnostic tests were small and absolute values were low for all tests. Patient perception will not be a key feature in determining an optimal diagnostic strategy in faecal incontinence.
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Affiliation(s)
- M Deutekom
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
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Allgayer H, Dietrich CF, Rohde W, Koch GF, Tuschhoff T. Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scand J Gastroenterol 2005; 40:1168-75. [PMID: 16165701 DOI: 10.1080/00365520510023477] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The influence of irradiation on the clinical severity of incontinence, sphincter function, morphologic features and short/long-term treatment effects of sphincter training therapy is still insufficiently understood in irradiated patients with fecal incontinence after surgery for colorectal cancer. These parameters were compared in irradiated and non-irradiated patients and followed prospectively with regard to short- and long-term training effects. MATERIAL AND METHODS Forty-one patients having been irradiated after surgery (50.0+/-5.0 Gy) and 54 non-irradiated patients with fecal incontinence participated in this prospective, non-randomized trial. Baseline evaluation included a semiquantitative severity assessment score of fecal incontinence (modified Cleveland Incontinence Score (MCIS)), rectal manometry and endoscopy. After 3 weeks (short term) of intensive in-hospital pelvic floor exercise combined with biofeedback training, a second evaluation was made. In addition, anal endosonography (EUS) was performed in cases of treatment failure. After one year (long term) a third evaluation was made clinically (MCIS score). RESULTS Irradiated patients presented with a significantly higher degree of fecal incontinence (lower MCIS) compared to non-irradiated patients: 7.4+/-2.2 versus 8.7+/-2.7 points (p<0.001). Rectosigmoidal inflammation was more frequent in irradiated than non-irradiated patients (26.9% versus 9.3%) (p<0.03). Sphincter pressure, sensation/pain threshold and the rectoanal inhibitory reflex were similar in both groups. A significant short-term training effect was observed in both groups following sphincter training therapy in terms of an increase in MCIS from 7.4+/-2.2 to 9.4+/-2.7 points in the irradiated group and from 8.7+/-2.7 to 11.4+/-2.5 points in the non-irradiated group (p<0.0001). After one year the scores were 8.2+/-3.8 and 10.7+/-4.4 points, respectively (p<0.0001). There was a significant correlation (p<0.001) between baseline MCIS and the short- and long-term MCIS. In patients with short-term treatment failure (16.6%) anal EUS revealed structural defects of the external sphincter in four patients. There was no association of sphincter diameter with sphincter pressure, sensation/pain threshold and short/long-term MCIS. CONCLUSIONS The main result of this study is that irradiated patients show short- and long-term training effects comparable with those of non-irradiated patients despite the higher degree of incontinence at baseline. The correlation between the initial MCIS and short- and long-term treatment effects may be regarded as an important clinical predictor for treatment outcome. Functional and morphologic features are less suitable for this purpose.
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Affiliation(s)
- Hubert Allgayer
- Department Oncology, Rehaklinik Ob der Tauber der LVA Baden-Württemberg, Bad Mergentheim, Academic Teaching Hospital, University of Heidelberg, Bad Mergentheim, Germany.
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