Biofeedback Training Fecal Incontinence in Children
Biofeedback Training Fecal Incontinence in Children
Fecal incontinence (FI) is the inability to control bowel movements, causing stool to leak
 from rectum it ranges from an occasional leakage of stool while passing gas to a complete
 loss of bowel control after the age of 4 years1. Functional non-retentive fecal incontinence
 (FNRFI) is fecal incontinence in a child with a mental age of more than 4 years with no
 evidence of metabolic, inflammatory, or anatomical cause2.

 The long-term result of biofeedback therapy is one of the most important subjects of
 controversy, and few studies have extended to 2 years of follow-up 11. So, the purpose of
 this study was to evaluate quantitatively the short-term and long-term efficacy of
 biofeedback training as a treatment tool designed to control functional non-retentive fecal
 incontinence in children and its long term impact on the quality of life.
Functional non-retentive fecal incontinence (FNRFI) is fecal incontinence in a child with a
 mental age of more than 4 years with no evidence of metabolic, inflammatory, or anatomical
 cause2.

 It is an extremely embarrassing and psychologically frustrating shameful problem with a bad
 impact on children3. It can lead to social isolation, loss of self-confidence, depression,
 and behavioral problems4. The underlying mechanism of functional non-retentive fecal
 incontinence is largely unknown. The pathophysiology seems to be complex and it is considered
 to be a multifactorial disorder5. Approximately 95% of the children had no organic cause and
 these children are considered to have a functional defecation disorder. Of this, in
 approximately 80% of these children FI is results of constipation and is treated with
 laxatives, the remaining 20% without signs of fecal retention is classified as FNRFI6 The
 negative psychological and social impact for these children is high, however, and requires
 adequate intervention7. Biofeedback therapy is a feasible option that has been used for fecal
 incontinence over several decades8. The underlying premise of biofeedback, as with learning
 any physical activity, is that "practice makes perfect" if the learner is provided with
 accurate feedback to make adjustments to optimize performance So, the purpose of this study
 was to evaluate quantitatively the short-term and long-term efficacy of biofeedback training
 as a treatment tool designed to control functional non-retentive fecal incontinence in
 children and its long term impact on the quality of life.

 Methods:

 The present study included 100 children of both sexes that were included with an age ranged
 from (5-14 years) with FNRFI with normal bowel habits, normal defecation frequency, and
 normal stool consistency with incontinence score ranging from 6-24 according to Vaizey score
 12. Exclusion criteria included; children who have traumatic sphincter injury, fecal
 impaction, spinal diseases causing incontinence, anorectal malformation, and children who
 were not cooperative. Patients included in this study were randomly divided and allocated
 into two groups Control group and Study group. Written informed consent was obtained from
 parents of all included children.

 A detailed history was taken including bowel habits, duration history of trauma. Complete
 physical examination to exclude patients requiring surgical correction.
Inclusion Criteria:

 -  Age ranged from (5-14 years) with FNRFI with normal bowel habits

 -  Children with normal defecation frequency and normal stool consistency

 -  Children with incontinence score ranging from 6-24 according to Vaizey score

 Exclusion Criteria:

 -  Children who have traumatic sphincter injury.

 -  Children who have Fecal impaction

 -  Children who have Spinal diseases causing incontinence

 -  Children who have Anorectal malformation

 -  Children who were not cooperative