Triple-Target Treatment Versus Low-Frequency Electrostimulation for Anal Incontinence

Schwandner, T.; Hemmelmann, Claudia; Heimerl, Tankred; Kierer, Walter; Kolbert, G.; Vonthein, Reinhard; Weinel, Rolf; Hirschburger, Markus; Ziegler, Andreas; Padberg, Winfried

doi:10.3238/arztebl.2011.0653

Cited by 14 publications

(30 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The group has published a RCT comparing 3T to standard EMG biofeedback in 2010 and another in 2011 comparing 3T to the more standardly used LFS. 33,36 The 2010 study was significantly underpowered because less than 40% of their subjects completed the 9-month treatment protocol, but the intention to treat analysis demonstrated improved continence in the 3T group. The 2011 study showed statistically significant improvements in continence in the 3T group compared with standard LFS; however, the LFS group did not have EMG biofeedback and the 3T group did.…”

Section: Summary Of Selected Trials Involving Both Biofeedback and Comentioning

confidence: 99%

Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence

Scott

2014

Clinics in Colon and Rectal Surgery

View full text Add to dashboard Cite

Fecal incontinence (FI) is a prevalent problem that can drastically affect quality of life. Pelvic floor rehabilitation is an important first-line treatment for patients with FI, and many published case reports and a small number of randomized controlled trials (RCTs) provide limited evidence for its efficacy. Pelvic floor rehabilitation approaches to the treatment of FI include pelvic floor muscle training, biofeedback, and volumetric training with rectal balloon catheters. Various forms of external electrical stimulation have also been described and may be of added benefit. Behavioral bowel retraining is an important part of a good rehabilitative approach as well. Pelvic floor rehabilitation treatment for FI is thought to be effective and safe, with reported success rates in a majority of studies at 50 to 80%. Many more high-quality RCTs are needed to define optimal treatment protocols.

show abstract

Section: Summary Of Selected Trials Involving Both Biofeedback and Comentioning

confidence: 99%

Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence

Scott

2014

Clinics in Colon and Rectal Surgery

View full text Add to dashboard Cite

show abstract

“…When judging the efficacy of the ES treatment or the combination of BF and ES (BF + ES), current type, current strength, and application mode are essential [ 6 – 10 ], as recently discussed by Schwandner et al [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Electrical stimulation and biofeedback for the treatment of fecal incontinence: a systematic review

Vonthein

Heimerl

Schwandner

et al. 2013

Int J Colorectal Dis

Self Cite

View full text Add to dashboard Cite

PurposeThis systematic review determines the best known form of biofeedback (BF) and/or electrical stimulation (ES) for the treatment of fecal incontinence in adults and rates the quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation. Attention is given to type, strength, and application mode of the current for ES and to safety.MethodsMethods followed the Cochrane Handbook. Randomized controlled trials were included. Studies were searched in The Cochrane Library, MEDLINE, and EMBASE (registration number (PROSPERO): CRD42011001334).ResultsBF and/or ES were studied in 13 randomized parallel-group trials. In 12 trials, at least one therapy group received BF alone and/or in combination with ES, while ES alone was evaluated in seven trials. Three (four) trials were rated as of high (moderate) quality. Average current strength was reported in three of seven studies investigating ES; only two studies reached the therapeutic window. No trial showed superiority of control, or of BF alone or of ES alone when compared with BF + ES. Superiority of BF + ES over any monotherapy was demonstrated in several trials. Amplitude-modulated medium-frequency (AM-MF) stimulation, also termed pre-modulated interferential stimulation, combined with BF was superior to both low-frequency ES and BF alone, and 50 % of the patients were continent after 6 months of treatment. Effects increased with treatment duration. Safety reporting was bad, and there are safety issues with some forms of low-frequency ES.ConclusionsThere is sufficient evidence for the efficacy of BF plus ES combined in treating fecal incontinence. AM-MF plus BF seems to be the most effective and safe treatment.Key Messages• The higher the quality of the randomized trial the more likely was a significant difference between treatment groups.• Two times more patients became continent when biofeedback was used instead of a control, such as pelvic floor exercises.• Two times more patients became continent when biofeedback plus electrical stimulation was used instead of biofeedback only.• Low-frequency electrical stimulation can have adverse device effects, and this is in contrast to amplitude-modulated medium-frequency electrical stimulation.• There is high quality evidence that amplitude-modulated medium-frequency electrical stimulation plus electromyography biofeedback is the best second-line treatment for fecal incontinence.Electronic supplementary materialThe online version of this article (doi:10.1007/s00384-013-1739-0) contains supplementary material, which is available to authorized users.

show abstract

“…Although innumerable measures, scales and composite indices have been used, there is no acceptable gold standard or outcome measure. A selected list of recent RCTs spanning medical, biofeedback, injectable and surgical interventions are summarized in Table . This highlights the disparities in subject selection, trial design, outcome measures and risk of bias.…”

Section: Defining and Validating A Fi Endpointmentioning

confidence: 99%

Endpoints for therapeutic interventions in faecal incontinence: small step or game changer

Rao

2016

Neurogastroenterology Motil

View full text Add to dashboard Cite

Fecal incontinence (FI) is common and its pathophysiology and treatments continue to evolve. However, a standard measure(s) for assessing its clinical outcome has been elusive. Consequently, over 100 measures and scoring systems, each with intrinsic biases have been reported. These include adequate relief or global satisfaction, ≥ 50% reduction in episodes or days without FI, quality of life (QOL), FI severity scales and composite indices. Earlier scales relied on the frequency and type of solid, liquid or flatus incontinence and effects on life style whereas newer scales have incorporated urgency, use of pads, antidiarrheals and amount of leakage, using prospective daily stool diaries or retrospective weekly or single point assessments. Such a plethora of measures have negatively impacted the assessment and outcome of clinical trials, and have made comparisons difficult. So, how does one sort out the grain from the chaff? In a provocative, post-hoc analysis published in this issue, the minimal clinically important difference, i e the smallest change detected by an instrument that is associated with a clinically meaningful change was used to assess FI endpoint Based on this a ≥ 50% reduction in FI episodes is recommended as a clinically meaningful outcome measure when assessed by stool diary, and it correlate with symptoms and severity. However, this requires further validation in multi-center, longer duration and therapeutically effective clinical trial(s). Simultaneous assessment of coping strategies, QOL and psychosocial domains can provide further insights regarding the overall impact of treatments . This mini-review discusses the advances and controversies in defining meaningful FI endpoints.

show abstract

Triple-Target Treatment Versus Low-Frequency Electrostimulation for Anal Incontinence

Cited by 14 publications

References 29 publications

Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence

Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence

Electrical stimulation and biofeedback for the treatment of fecal incontinence: a systematic review

Endpoints for therapeutic interventions in faecal incontinence: small step or game changer

Contact Info

Product

Resources

About