The IX t h Makassed Medical Congress - American University of Beirut

SUCCESSFUL USE OF BIOFEEDBACK FOR THE TREATMENT OF DEFECATION
DISORDERS AND VESICO-SPHINCTERIC DYSSYNERGIA IN CHILDREN
ADIB MOUKARZEL
To evaluate the effectiveness of biofeedback in children, we retrospectively reviewed clinical and
manometric parameters of outpatients referred to pour Ped GI private office in two locations. They
were divided in 3 groups: Group 1-functional constipation or encopresis (n = 42): biofeedback
indicated when symptoms fail to respond to 12 months of conservative treatment or presence
of high EMG activity in pelvie floor muscles with evidence of rectal or anal canal pain. A pelvic
floor dyssynergia (obstructive defecation ot anismus, failure to relax the pelvic floor muscles
during attempts to defecate) was present in 75% of these children. Group 2 (n = 23) included
children with fecal incontinence following surgery for imperforated anus, Hirshsprung’s disease or
meningomycelocele. Biofeedback training was directed toward teaching sphincter contraction,
improving sensory impairment and coordination of sensation with squeeze or defecation. Group
3 included 14 subjects with vesicosphincteric dysynergia. The principle of therapy and the
technique used are the same as for the ano-rectal biofeedback. Using a computerized device
that measures pelvic floor muscle strength and sphincter tone by pressure sensors and/or stickon
surface EMG electrodes, the child is showed how to propel kegel exercises and relax muscles
tone by watching a color TV monitor and listening to the sound generated. We have developed
for young children a special display based on commonly used video or computer games. The
treatment continued at home included keeping toilet diaries, home exercises with the use of a
Foley catheter, and a diet modification.
Results:
The mean age was 8.2 ±1.4 years (range 4 -16). The mean number of biofeedback sessions
was 7.3 ± 2.8. Group 2 needed significantly more sessions (9.4 ± 2.4, p< 0.05) than group 1 or 3.
Overall, there was a significant improvement in 96%; 73% became completely asymptomatic.
The improvement was maintained for 25 ± 6 months. There was a significant decrease in the
sensation threshold (34.6 ±9.8 to 4.5 ± 2.5 ml). When present, there was a significant (p