Careful selection required: options abound for treating patients who have fecal incontinence.(Gynecology)

FORT LAUDERDALE, FLA. -- Many modalities can bring relief and improve the quality of life of patients with fecal incontinence, but physicians must weigh the potential risks and benefits of conservative and surgical treatments, speakers said at a colorectal disease symposium sponsored by the Cleveland Clinic Florida.

"With whatever intervention we offer, we have to give them an accurate appraisal of what we can achieve," said Dr. David C.C. Bartolo of Western General Hospital, Edinburgh, Scotland.

The speakers reviewed the outcomes of some of the modalities that have been used for treating fecal incontinence:

* Biofeedback. A patient can work to improve his or her control over physiologic functions by observing their reactions on external equipment such as electromyography, manometry, or endoanal ultrasound, according to Dr. Olaf Hallbook of the division of colorectal surgery at University Hospital in Linkoping, Sweden.

But fecal incontinence can have several causes, especially in older age, including factors related to the intestines and the peripheral and central nervous systems. In more than 50 studies on biofeedback since 1974, the overall success rate has been 72% in patients with diverse physiologic problems. Many of the studies had methodologic weak-nesses such as poor categorization of patients, inadequate end points, and few long-term results.

The Cochrane collaboration concluded in 2003 that only 4 of the more than 50 studies met criteria for evidence-based medicine. Overall, the Cochrane group could not verify that biofeedback is effective, or determine which patients are most likely to be helped, Dr. Hallbook said.

Two studies published after the Cochrane review used well-defined end points, were sufficiently large, had excellent characterization of the patients, and followed patients for 1 year. But biofeedback was not compared with surgery or other treatments.