Pelvic Muscle Exercises And Biofeedback - Treating Fecal Incontinence: Bladder Conditions

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Pelvic muscle exercises and biofeedback

No matter what causes your fecal incontinence, you may be advised to use Kegel exercises (see "Pelvic floor exercises") to strengthen your pelvic floor and sphincter muscles. Although there are not good data comparing pelvic muscle exercises to other treatments (or to no treatment at all), the exercises are a good first step and can be combined with other treatments.

Biofeedback training may help fecal incontinence in two ways — by helping you strengthen and coordinate the action of your sphincter muscles and by improving your ability to sense the presence of stool in the rectum.

During a biofeedback session aimed at strengthening your pelvic muscles, the practitioner inserts a slim sensor into your rectum (in women, it is sometimes placed in the vagina, or an additional sensor is used). Other electrodes on your abdomen help record muscle contractions there. A computer screen provides feedback about the strength of your contractions and whether you are using the correct muscles.

If the biofeedback training is aimed at improving your ability to sense stool in the rectum, the practitioner will use anorectal manometry equipment to vary the pressure in your rectum.

Whether biofeedback will help depends on the cause and severity of your incontinence and your ability to learn and practice the exercises. According to an international consensus panel that met in 1999, biofeedback helps about 75% of people with fecal incontinence, providing complete relief for about 50%. Some controlled trials demonstrated only modest improvements, but biofeedback and exercise are so safe they are usually recommended prior to more invasive treatments. You are most likely to benefit if your incontinence is due to nerve damage caused by vaginal deliveries, but biofeedback also aids some people with minor structural defects in their sphincters.

Pelvic muscle conditioning without exercise. Electrical stimulation (see "Conditioning without exercise") is sometimes used to treat fecal incontinence. Although there are numerous reports of its value, no controlled studies have clearly demonstrated its relative effectiveness in comparison with biofeedback or no treatment. In one 2006 British study, electrical stimulation modestly improved bowel control, but so did a placebo treatment of low-level electrical stimulation. When biofeedback supplemented with electrical stimulation was compared with biofeedback alone in treating postpartum fecal incontinence, both groups benefited equally. Nationally, Medicare does not require or prohibit coverage for this treatment for fecal incontinence. Local carriers make the decision.

Magnetic stimulation of the pelvic floor muscles (see "Conditioning without exercise"), already FDA-approved for treating urinary incontinence, improved patient ratings and pressure measurements related to bowel control in a pilot study on fecal incontinence.

Last updated:	September 05, 2008