biofeedback for faecal incontinence and constipation by courtesy of christine norton phd ma rn nurse...
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Biofeedback for Faecal Incontinence and ConstipationBy courtesy of
Christine Norton PhD MA RN
Nurse Consultant (Bowel Control) &
Professor of Gastrointestinal Nursing
St Mark’s Hospital & Kings College
London, United Kingdom
What is “Biofeedback”?
• Whatever you want it to be?• Use of equipment to record or amplify
biological signals normally unnoticed, to enable the individual to alter function or responses
• Huge variety of protocols– 1-28 sessions– Daily-monthly– Few described intervention or used controls
3 main modalities for FI• Strength training: feedback of squeeze increment
to enhance performance of exercises– EMG (surface or intra-anal) (17 studies)– Pressure (water perfused, solid state, air balloon)– Ultrasound (anal or vaginal) (2 studies)
• Increase voluntary squeeze response to rectal distension (co-ordination)
• Rectal balloon: decrease threshold of sensation to rectal filling, or increase threshold for urgency
• Combinations
Systematic review of biofeedback for FI• 46 studies identified in adults in English
• Total of 1364 patients
• 49% no incontinence, 72% cured or improved
• Only one study showed no improvement• Poor outcome measures, no standard
technique (Norton & Kamm, Alimentary Pharmacology & Therapeutics, 2001)
• Now (2006) 65+ case series
Problems with case series
• Publication bias (negative studies not published?)
• We all talk to patients (hopefully)• Known effect of intervening per se (placebo
response is high in functional gut disorders)• Confounding effect of: time, attention, patient
education and understanding, reassurance that symptoms not sinister, advice on diet, titration of medication…etc
• Is it biofeedback that is effective??
Elements of “Biofeedback”
• Nurse / physiotherapist led service• Patient teaching and understanding• Sphincter isolation & exercises (+ home practice)
Strength, endurance, speed of reaction
• Behaviour modification - urge resistance +/- balloon distension & co-ordination
• Diet, caffeine, lifestyle• Practical coping & medication titration• Emotional support• Which are the important elements?(Norton & Chelvanayagam, JWOC Nursing, 2001)