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
Cite this Article As :
Varman A, Kucukkartallar T, Cakir M, Yildirim MA, Senturk M, Alkan S, Kisi O, Kocamaz AH, Celik A. Effects of Biofeedback Treatment
on Anal Incontinence Before Closing The Protective Ileostomy in Patients Undergoing Low Anterior Resection. Selcuk Med J 2025;41(3): 124-130
1- Bharucha AE, Knowles CH, Mack I, et al. Faecal incontinence in adults. Nat Rev Dis Primers. 2022;8(1):53. Published 2022 Aug 10. doi:10.1038/s41572-022-00381-7
2- Guillaume A, Salem AE, Garcia P et al. Pathophysiology and Therapeutic Options for Fecal Incontinence. J Clin Gastroenterol. 2017;51(4):324-330. doi:10.1097/MCG.0000000000000797
3- Duman A. Ceviz C. Sönmez S. et al. Kolon Ve Rektum Kanseri Konusunda Klinik Araştırma Selçuk Üniv Tıp Derg. 1984 1-1 (59-70).
4- Dulskas A, Smolskas E, Kildusiene I et al. Treatment possibilities for low anterior resection syndrome: a review of the literature. Int J Colorectal Dis. 2018;33(3):251-260. doi:10.1007/s00384-017-2954-x
5- Knol ME, Snijders HS, van der Heyden JT et al. Fecal Incontinence: The Importance of a Structured Pathophysiological Model. J Anus Rectum Colon. 2022;6(1):58-66. Published 2022 Jan 28. doi:10.23922/jarc.2021-040
6- Kutlu R. at all Depression and the Factors Affecting the Quality of Life in Cancer Patients. Selçuk Üniv Tıp Derg 2011;27(3):149-153
7- Deb B, Prichard DO, Bharucha AE. Constipation and Fecal Incontinence in the Elderly. Curr Gastroenterol Rep. 2020;22(11):54. Published 2020 Aug 24. doi:10.1007/s11894-020-00791-1
8- Arnouk A, De E, Rehfuss A et al. Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders. Curr Urol Rep. 2017;18(6):47. doi:10.1007/s11934-017-0694-7
9- Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922-928. doi:10.1097/SLA.0b013e31824f1c21
11- Brown CJ, Fenech DS, McLeod RS. Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev. 2008;2008(2):CD006040. Published 2008 Apr 16. doi:10.1002/14651858.CD006040.pub2
12- Visser WS, Te Riele WW, Boerma D er al. Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review. Ann Coloproctol. 2014;30(3):109-114. doi:10.3393/ac.2014.30.3.109
13- Bø K. Can pelvic floor muscle training prevent and treat pelvic organ prolapse?. Acta Obstet Gynecol Scand. 2006;85(3):263-268. doi:10.1080/00016340500486800
14- Rao SS, Benninga MA, Bharucha AE et al. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil. 2015;27(5):594-609. doi:10.1111/nmo.12520
15- Lee BH, Kim N, Kang SB et al. The Long-term Clinical Efficacy of Biofeedback Therapy for Patients With Constipation or Fecal Incontinence. J Neurogastroenterol Motil. 2010 Apr;16(2):177-85. doi: 10.5056/jnm.2010.16.2.177. Epub 2010 Apr 27. PMID: 20535349; PMCID: PMC2879852.
16- Pehl C, Seidl H, Scalercio N, et al. Accuracy of anorectal manometry in patients with fecal incontinence. Digestion. 2012;86(2):78-85. doi:10.1159/000338954
17- Yeap ZH, Simillis C, Qiu S et al. Diagnostic accuracy of anorectal manometry for fecal incontinence: a meta-analysis. Acta Chir Belg. 2017;117(6):347-355. doi:10.1080/00015458.2017.1394674
18- Bright T, Kapoor R, Voyvodich F et al. The use of a balloon catheter to improve evaluation in anorectal manometry. Colorectal Dis. 2005;7(1):4-7. doi:10.1111/j.1463-1318.2004.00698.x
19- Laforest A, Bretagnol F, Mouazan AS et al. Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life?. Colorectal Dis. 2012;14(10):1231-1237. doi:10.1111/j.1463-1318.2012.02956.x
20- Pucciani F. Post-surgical fecal incontinence. Updates Surg. 2018;70(4):477-484. doi:10.1007/s13304-017-0508-y
21- Rasmussen OO, Petersen IK, Christiansen J. Anorectal function following low anterior resection. Colorectal Dis. 2003;5(3):258-261. doi:10.1046/j.1463-1318.2003.00439.x
22- Di Matteo G, Mascagni D, Zeri KP, et al. Evaluation of anal function after surgery for rectal cancer. J Surg Oncol. 2000;74(1):11-14. doi:10.1002/1096-9098(200005)74:13.0.co;2-d