Effects Of Biofeedback Treatment on Anal Incontınence Before Closıng The Protectıve Ileostomy in Patıents Undergoing Low Anterior Resectıon

ABSTRACT
Objective: This study aimed to investigate whether biofeedback therapy performed while the anal sphincter was passive (before the closure of protective ileostomy) had any preventive or reducing effect on postoperative incontinence development in patients undergoing low anterior resection and protective ileostomy for rectal carcinoma. Additionally, the study sought to evaluate the impact of biofeedback therapy on anorectal manometry measurements, quality of life, and overall functional outcomes.
Materials and Methods: This study included patients who underwent low anterior resection and protective ileostomy at the General Surgery Clinic of Necmettin Erbakan University, Meram Medical Faculty. A total of 40 patients were randomly divided into two groups of 20 individuals each. The study group received biofeedback exercise therapy, which was administered twice a week for four consecutive weeks prior to the ileostomy closure. The control group did not receive any exercise therapy. Two weeks after the ileostomy closure, anorectal manometry measurements were performed for both groups. Clinical outcomes were assessed using the Cleveland Clinic/Wexner Incontinence Score , the low anterior resection syndrome score, and the Cleveland Clinic-developed Quality of Life Questionnaire.
Results: Patients who received biofeedback exercise therapy demonstrated higher "average resting pressure" in anorectal manometry measurements performed after ileostomy closure. According to the LARS scoring, the study group experienced less incontinence and a lower frequency of daytime defecation compared to the control group. These findings suggest a significant improvement in anal sphincter functionality.
Conclusion: The results of this study indicate that biofeedback therapy performed before ileostomy closure improves postoperative low anterior resection syndrome symptoms and enhances specific anorectal manometric parameters. These findings are promising and highlight the potential of biofeedback therapy as an effective intervention in this patient population.
Keywords: Fecal incontinence, rectal cancer, biofeedback therapy