The use of biofeedback in treatment of fecal incontinence : a systematic review

Introduction: The treatment of fecal incontinence using biofeedback techniques goes back to the 70s, however their effectiveness is controversial. Objective: To update and determine the best scientific evidence on this therapy. Methods: A systematic review following the principles proposed by the Cochrane Handbook was performed from 1970 using databases as: Cinahl Complete, Medline Complete, Cochrane Central Register of Controlled Trials, Medic Latina, Scielo, Elsevier, Repositório Cientifico de Acesso Aberto em Portugal (RCAAP) and Coordenação de Aperfeiçoamento de pessoal de nível superior (CAPES). The inclusion criteria were: adults (+ 18 years old), with deficiency of the pelvic floor muscles due to sphincter injury or denervation of the pelvic floor. Exclusion criteria: childs, neurologic diseases (like stroke), multiple sclerosis, irritable bowel syndrome, abuse of laxatives and scleroderma. Results: Initially we found 1726 studies, after applying the inclusion and exclusion criteria we reduced this number to 11. For the critical appraisal of the studies we used the scale from the Centre for Evidence Based Medicine of Faculty of Medicine Lisbon and we excluded 1 article. Finally, the main corpus of the study had 10 studies (2 randomized controlled trials and 8 prospective studies). Preliminary results show that studies used diferent evaluation parameters: from anal manometry, Cleveland Clinic Florida Fecal Incontinence scale to the Fecal incontinence Severity Index. Conclusions: We found a shortness of quality studies available on this subject and the methodological limitations make it difficult to compare study results. We suggest a standardization of instruments and definitions as essential for the improvement of scientific knowledge in the area.