Objectives: Fecal incontinence commonly happened as residual symptoms in anorectal malformation following correction surgery. The condition represents personal hygiene matters and psychological distress of the children. Pelvic floor exercises proven to improve fecal and urinary incontinence of adults with several conditions, however this exercises unreliable to be performed by children. Biofeedback mediated pelvic floor exercises have been shown to improve strength of anal sphincter by gradual exercise on precise level of intensity. The authors are stressing on adjunct of intra-anal application of electrical stimulation to enhance contractility of the sphincter.
Design: Thirty six post surgical of anorectal malformation-patients (mean age 6.67 +0.9 years old) were randomly sorted into two groups, the first group with biofeedback exercise and sham stimulation, and intervention group underwent biofeedback exercise plus 6 mA stimulation. Intervention was performed 12 times for 4 weeks. The level of anal sphincter contractility were recorded with Enraf Myomed 632 and unintentional voiding/defecation documented 3 times; before and after intervention, and three weeks post-treatment. Paired T-test to compare improvement among groups.
Results: From Thirty six patients, both groups has shown significant effect in sphincter contraction at the end of program compare with pre-treatment values (p < 0.05). No significant difference in both groups after 3 weeks compare with pre-treatment value (p >0,05). There was statistically significant difference of sphincter contraction strength improvements between study groups in the end of program (13,417+2,97 hPa vs 10,322+3,07 hPa; p< 0,0001), however there is no significant difference after 3 weeks without program ( 7,372 +1,85 vs 6,456 +2,26). Fecal incontinence was not statistically improved in both study groups.
Conclusions: Our study result suggests biofeedback mediated exercise plus electrical stimulation seems more effective in increasing tone of sphincter sub-clinically than biofeedback mediated exercise alone. Nevertheless both seem does not improve fecal continence.
Husnul Mubarak– Head of Department, Physical Medicine and Rehabilitation Medical Faculty Hasanuddin University
Tommy Habar– Medical Staff, Paediatric Surgery Medical Faculty Hasanuddin University
Nilla Mayasari– Head of PMR Unit, Wahidin General Hospital
Anshory Sahlan– Medical Staff, Hasanuddin University Hospital