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Tuttle LJ, Zifan A, Swartz J, et al. Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence?. Neurogastroenterol Motil. 2021;34(1):e14212doi: 10.1111/nmo.14212.
Tuttle, L. J., Zifan, A., Swartz, J., & Mittal, R. K. (2022). Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence?. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 34(1), e14212. https://doi.org/10.1111/nmo.14212
Tuttle, Lori J, et al. "Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence?." Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society vol. 34,1 (2022): e14212. doi: https://doi.org/10.1111/nmo.14212
Tuttle LJ, Zifan A, Swartz J, Mittal RK. Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence?. Neurogastroenterol Motil. 2022 Jan;34(1):e14212. doi: 10.1111/nmo.14212. Epub 2021 Jul 08. PMID: 34236123; PMCID: PMC8712345.
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Neurogastroenterol Motil. 2022 Jan;34(1):e14212. doi: 10.1111/nmo.14212. Epub 2021 Jul 08.

Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence?.

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

Lori J Tuttle, Ali Zifan, Jessica Swartz, Ravinder K Mittal

Affiliations

  1. Doctor of Physical Therapy Program, School of Exercise & Nutritional Sciences, San Diego State University, San Diego, California, USA.
  2. Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, USA.

PMID: 34236123 PMCID: PMC8712345 DOI: 10.1111/nmo.14212

Abstract

AIM: To determine if a biofeedback therapy that includes concentric resistance exercise for the anal sphincter muscles can improve muscle strength/function and improve AI symptoms compared to the traditional/non-resistance biofeedback therapy.

BACKGROUND: Biofeedback therapy is the current gold standard treatment for patients with anal incontinence (AI). Lack of resistance exercise biofeedback programs is a limitation in current practice.

METHODS: Thirty-three women with AI (mean age 60 years) were randomly assigned to concentric (resistance) or isometric (non-resistance) biofeedback training. Concentric training utilized the Functional Luminal Imaging Probe to provide progressive resistance exercises based on the patient's ability to collapse the anal canal lumen. Isometric training utilized a non-collapsible 10 mm diameter probe. Both groups performed a biofeedback protocol once per week in the clinic for 12 weeks and at home daily. High definition anal manometry was used to assess anal sphincter strength; symptoms were measured using FISI and UDI-6. 3D transperineal ultrasound imaging was used to assess the anal sphincter muscle integrity.

RESULTS: Concentric and isometric groups improved FISI and UDI-6 scores to a similar degree. Both the concentric and isometric groups showed small improvement in the anal high-pressure zone; however, there was no difference between the two groups. Ultrasound image analysis revealed significant damage to the anal sphincter muscles in both patient groups.

CONCLUSIONS: Concentric resistance biofeedback training did not improve the anal sphincter muscle function or AI symptoms beyond traditional biofeedback training. Anal sphincter muscle damage may be an important factor that limits the success of biofeedback training.

© 2021 John Wiley & Sons Ltd.

Keywords: anal sphincter; biofeedback; fecal incontinence; pelvic floor; strength training

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