Behavioral management of fecal incontinence in adults Christine Norton  Gastroenterology  Volume 126, Pages S64-S70 (January 2004) DOI: 10.1053/j.gastro.2003.10.058

Figure 1 One hundred seventy-one patients who were incontinent of solid or liquid stool were assessed by anal ultrasound and then assigned to 1 of 2 groups: those with structurally intact anal sphincter muscles and those with disrupted anal sphincter muscles. Patients in each of these 2 groups were further randomized to 1 of 4 treatment subgroups: (1) standard medical/nursing care (up to six 1-hour sessions of information and advice); (2) same as subgroup 1 plus verbal instruction and a leaflet explaining sphincter exercises; (3) same as subgroup 2 plus hospital-based computer-assisted sphincter manometric pressure biofeedback at each session; or (4) same as subgroup 3 plus use of a home EMG biofeedback device. On an intention-to-treat analysis, biofeedback yielded no greater benefit than standard care (54% improved in group 1 vs. 53% in group 3). Overall, 75% of patients who completed treatment reported symptomatic improvement, and 5% were, by their own assessment, “cured.” For all groups combined, the median number of incontinent episodes per week decreased from 2 to 0 (P < 0.001). For all improvements that were registered in the study, there were no significant differences between the treatment groups. Reprinted with permission.45 Gastroenterology 2004 126, S64-S70DOI: (10.1053/j.gastro.2003.10.058)