Biofeedback pelvic floor muscle training and posterior tibial nerve electrostimulation for treatment of faecal incontinence: monotherapy versus combined therapy: a prospective randomized trial

Abstract

Background Faecal incontinence is a common anorectal medical trouble among adult population. The aim was to compare the efficacy of biofeedback pelvic floor muscle training versus posterior tibial nerve electrical stimulation versus combination of both of them in treatment of patients with faecal incontinence. The study included 71 randomly selected patients with faecal incontinence. Eleven patients had one or more exclusion criteria were excluded from the study. Sixty patients were included in the trial. They were randomly assigned to receive biofeedback pelvic floor muscle training (biofeedback group), posterior tibial nerve electrostimulation (posterior tibial nerve electrostimulation group) or combined therapy (combined group). Primary outcome measure was Wexner Faecal Continence scale. Secondary outcome measures were maximal squeezing anal pressure, maximal voluntary anal contraction time and patient global assessment of effect of faecal incontinence on quality of life. The outcome measures were recorded twice, before treatment and after treatment by six weeks. Results No statistical significant differences were present between the three groups regarding different baseline clinical characteristics. Significant differences were present between the initial and follow-up assessment of the outcome measures within the three groups. However, there were significant differences between the three groups regarding the outcome measures within follow-up assessment. There were 14 patients (70%) showed successful outcome in the combined group versus 11 patients (55%) in the biofeedback group and 6 patients (30%) in the posterior tibial nerve electrostimulation group. Conclusions Combination therapy of biofeedback pelvic floor muscle training and posterior tibial nerve electrostimulation in the treatment of patient with faecal incontinence is quantitatively better than biofeedback pelvic floor muscle training therapy alone and superior to posterior tibial nerve electrostimulation therapy alone, as well as biofeedback pelvic floor muscle training therapy is superior to posterior tibial nerve electrostimulation therapy. This combination could be recommended as an effective treatment for faecal incontinence. It increases the anal sphincter squeezing pressure with improvement in the patients’ quality of life. Trial registration: Pan African Clinical Trials Registry, PACTR202008862941254. Registered 24 August 2020—Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12291.

Biofeedback pelvic floor muscle training versus posterior tibial nerve electrostimulation in treatment of functional obstructed defecation: a prospective randomized clinical trial

“…No side effects occurred in any patient in both therapeutic groups. This was similar to the literature in which BF and PTNS were considered safe physical modalities and not associated with any side effects [ 13 , 15 , 16 , 30 , 31 , 36 – 38 , 54 ].…”

“…The study results were like other researches that assessed the efficacy of BF versus PTNS in FI and in overactive bladder in spite of different pelvic floor medical problems [ 29 , 30 , 55 ]. The higher success rate of BF group could be due to the active correction of the functional disturbance in the EAS and PR muscles associated with the high motivation in the participated patients [ 13 , 56 , 57 ].…”

“…The combination between two different modalities which act through two different mechanisms of action is considered a good choice for treatment as applied for other pelvic floor sphincteric disorders [ 29 , 30 , 55 ]. It is suspected to be the most effective method in combination with health education, dietary modification and life style modification in the treatment of functional OD.…”

“…5 Technique of pressure-based biofeedback pelvic floor muscle training [ 13 , 16 , 29 ]

Fig. 6 Technique of transcutaneous posterior tibial nerve electrostimulation [ 15 , 30 ]

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“…According to the results of the outcome measures in the post-treatment evaluation, the participants were grouped as having (i) improvement: if the patient had at least 50% improvement in the outcome measure after therapy. (ii) No improvement: if the patient had less than 50% improvement in the outcome measure after therapy [ 30 , 31 ].…”