Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence?

Abstract

Aim:To determine if a biofeedback therapy that includes concentric resistance exercise for the anal sphincter muscles can improve muscle strength/function and improve AI symptoms compared to the traditional/non-resistance biofeedback therapy.Background: Biofeedback therapy is the current gold standard treatment for patients with anal incontinence (AI). Lack of resistance exercise biofeedback programs is a limitation in current practice. Methods: Thirty-three women with AI (mean age 60 years) were randomly assigned to concentric (resistance) or isometric (non-resistance) biofeedback training. Concentric training utilized the Functional Luminal Imaging Probe to provide progressive resistance exercises based on the patient's ability to collapse the anal canal lumen. Isometric training utilized a non-collapsible 10 mm diameter probe. Both groups performed a biofeedback protocol once per week in the clinic for 12 weeks and at home daily.High definition anal manometry was used to assess anal sphincter strength; symptoms were measured using FISI and UDI-6. 3D transperineal ultrasound imaging was used to assess the anal sphincter muscle integrity.Results: Concentric and isometric groups improved FISI and UDI-6 scores to a similar degree. Both the concentric and isometric groups showed small improvement in the anal high-pressure zone; however, there was no difference between the two groups.Ultrasound image analysis revealed significant damage to the anal sphincter muscles in both patient groups. Conclusions: Concentric resistance biofeedback training did not improve the anal sphincter muscle function or AI symptoms beyond traditional biofeedback training. Anal sphincter muscle damage may be an important factor that limits the success of biofeedback training.

Fecal incontinence patients categorized based on anal pressure and electromyography: Anal sphincter damage and clinical symptoms

“…Whether biofeedback therapy improves anal sphincter function has also been fiercely debated 34 . We recently found and reported minimal improvement in the anal sphincter pressure following resistance exercises of the anal sphincter muscles 35 . The biofeedback in that study was provided by the dynamic changes in the anal sphincter diameter seen on the functional luminal imaging probe (FLIP) recordings.…”

Current and future perspectives on the utility of provocative tests of anal sphincter function: A state‐of‐the‐art summary

“…However, literature exists evaluating the resistance of the anal canal to distension in patients with FI 38,39,[43][44][45][46] and a limited number of healthy volunteers 9,11,47 during rest and voluntary squeeze, and using different measured parameters (Table 2). FLIP has also been compared against HRAM to establish its clinical utility in the evaluation of FI, 38,39,45 and used to observe the effects of neuromodulation, 48 biofeedback, 49 Naloxegol administration, 50 the STARR procedure, 51 and neoadjuvant chemoradiotherapy treatment for rectal 52 or anal cancer. 53 In all studies, the catheter was purged and calibrated at atmospheric pressure and the individual placed in the left lateral position with the lubricated catheter inserted into the anal canal such that only two detection electrodes were visible at the anal verge.…”

Research Advances of Biofeedback in Anorectal Department

“…There is a direct link between the severity of anxiety and anxiety and the patient's anorectal dynamics and rectal perception dysfunction. [36] The patient's anorectal dynamics and rectal dysfunction are directly related to the severity of anxiety and depression. A depressed or anxious psychological state may delay the course of the disease and postpone the recovery process, so the operator should be experienced and positive during treatment and can tailor individualised psychological counselling for the patient.…”