Quality of life and disease-specific functioning of patients with anorectal malformations or Hirschsprung's disease: a review.

The objective of this review was to examine disease-specific functioning (ie, faecal functioning and disease-related psychosocial problems) and quality of life (QoL)in patients with anorectal malformations (ARMs) or Hirschsprung's disease across different developmental stages. A search on PubMed yielded 22 eligible studies which were analysed. Patients with ARM or Hirschsprung's disease report slightly more QoL problems than comparison groups. As compared with adolescents, children reported better QoL but worse disease-specific functioning. Relationships between disease-specific functioning and QoL remain unclear. Therefore, to disentangle the complex relationship between the faecal functioning of these patients and their QoL through childhood, adolescence and adulthood, longitudinal studies should examine disease-specific functioning with validated QoL questionnaires that include age-specific versions.

Long-term outcomes of individualized biofeedback training based on the underlying dysfunction for patients with imperforate anus.

BACKGROUND: The aim of this study was to design an individualized biofeedback program based on the underlying dysfunctions and to assess the short-term and long-term clinical and quality-of-life outcomes for patients with imperforate anus. METHODS: Thirty-one patients were treated using an individualized biofeedback program according to their different dysfunctions after having completed the assessment of the anorectal function. Many special biofeedback training methods that consist of strengthening the perianal muscles biofeedback, sensory discrimination biofeedback, synchronizing external sphincter contraction biofeedback, and improving defecation dynamic biofeedback were selected to make up the individualized biofeedback training program. The clinical scores and quality-of-life scores were assessed in the short-term and long-term follow-up. RESULTS: The clinical scores and quality-of-life scores of patients before training, after biofeedback training, at short-term follow-up, and at long-term follow-up were 3.2 +/- 1.1 and 8.7 +/- 1.1, 5.2 +/- 0.6 and 11.0 +/- 0.8, 5.1 +/- 0.6 and 10.8 +/- 0.9, and 4.6 +/- 0.7 and 10.1 +/- 0.7, respectively. After biofeedback training, the strength of the perianal muscles were increased significantly, the abnormal rectal threshold sensation and defecation dynamic reverted to normal in all patients, and 82% patients who have no external anal sphincter reflex acquired the new reflex. In the short-term follow-up, 12 (57%) patients maintained the clinical outcome, and only 9 (43%) patients have regressions slightly. At long-term follow-up, 7 (33%) patients maintained the clinical outcome very well, and 14 (67%) patients had regressed. Although the clinical and quality-of-life scores have decreased slightly at follow-up, they were still significantly increased compared with those before biofeedback training. CONCLUSIONS: The individualized biofeedback is more suitable for improvement of the clinical outcome and the quality of life, and maintained a good clinical outcome and quality of life on the short-term and long-term follow-ups.

[Long-term outcomes of individualized biofeedback training based on the underlying dysfunction for patients with imperforate anus].

OBJECTIVE: Although better anorectal function was achieved due to the advanced operation procedures, the fecal incontinence and constipation still remain as major postoperative complications. The aim of this study was to design a individualized biofeedback program based on the underlying dysfunctions and to assess the short-term and long-term clinical and quality of life outcomes for patients with imperforate anus. METHODS: Thirty-one patients were treated using individualized biofeedback program according to their different dysfunctions after completed assessment of anorectal function. The many of special biofeedback training methods that consisted of the strengthening perianal muscles biofeedback, sensory discrimination biofeedback, synchronizing external sphincter contraction biofeedback and improving defecation dynamic biofeedback were selected to make up the individualized biofeedback training program. The clinical scores and quality of life scores were assessed at short-term and long-term follow-up. RESULTS: The clinical scores and quality of life scores in patients at before training group, after biofeedback training group, short-term follow-up group and long-term follow-up group were 3.2 +/- 1.1 and 8.7 +/- 1.1, 5.2 +/- 0.6 and 11.0 +/- 0.8, 5.0 +/- 0.6 and 10.8 +/- 0.9, and 4.6 +/- 0.7 and 10.0 +/- 0.7 respectively. After biofeedback training, the first leak volume and all parameters that evaluated the function of the perianal muscles were increased significantly, the abnormal rectal threshold sensations and defecation dynamics were reverted to normal, and 82% patients who have not external anal sphincter reflex acquired the new reflex. The latencies of pudendo-anal reflex have significant difference in patients with poor response compared with those patients with good response before and after the biofeedback training. At short-term follow-up 12 patients (57%) maintained the clinical outcome and only 9 patients (43%) have regressions slightly. At long-term follow-up 7 patients (33%) maintained the clinical outcome very well and 14 patients (67%) have regressions. Although the clinical and quality of life scores have decreased slightly at follow-up, they were still increased significantly compared with before biofeedback training group. CONCLUSION: The causes of postoperative fecal dysfunction in patients with imperforate anus are multifactorial, and the individualized biofeedback is more suitable for improvement of the clinical outcome and the quality of life, and it maintain good clinical outcome and quality of life at short-term and long-term follow-up.

Biofeedback therapy for anorectal disorders in children.

The physiological rationale, methodology, and results of biofeedback therapy in the management of anorectal disorders in children are presented. Balloon manometry and surface electromyography (EMG) are current biofeedback methods used to teach improved recognition of rectal distension and coordination of muscle function to either maintain fecal continence or to allow proper defecation. These techniques have permitted a success rate of over 70% in the management of children with functional or organic anorectal disease refractory to conventional medical and behavioral therapy. Biofeedback therapy is recommended to assist in the successful rehabilitation of these patients.

[Improving continence by biofeedback conditioning]. / Kontinenzverbesserung durch Biofeedback-Konditionierung.

In the last 10 years biofeedback training (BFT) has been used in 72 patients with anal continence disturbances following rectoanal agenesis, constipation, MMC, etc. Using the BF-method we treated 35 children with incontinence following rectoanal agenesis (5 infralevator, 30 supralevator). Visual analog feedback was used in the first 10 cases. Since 1982 simultaneous audiovisual analog signals have been preferred. The detailed analysis and personal followup over 6.5 years of these patients suggests that BFT improves the threshold of rectal sensation, voluntary contraction and thereby benefits anal continence.

[Biofeedback training and functional electrostimulation for improving incontinence in children with anal atresia]. / Biofeedback-Training und funktionelle Elektrostimulation zur Verbesserung der Inkontinenz bei Kindern mit Analatresie.

Eleven children with anal incontinence following a pull-through operation for anorectal agenesis (4 low, 7 high anomalies) were treated with a conservative continence training program (optic/acoustic biofeedback, transcutaneous electrical stimulation, physical therapy, contraction exercises and sensibility training). All patients with one exception showed subjective and objective improvement of continence. Sphincter contraction increased by 80% in high and by 40% in low anomalies. For a short time electrostimulation provided an improvement of up to 20% in sphincter pressure. One additional success was improved coordination. Beside surgical therapy and other methods continence training is always indicated.

[Biofeedback technic in incontinence in high ano-rectal atresia]. / Tecniche di biofeedback nella incontinenza della atresia ano-rettale alta.

Authors have employed biofeedback in functional rehabilitation of fecal incontinence after surgical treatment of high anorectal atresia. 34 patients have treated with that technique, of whom 27 underwent an levator plasty and 7 a muscular transplant procedure using a gracilis sling. A four channels Recording connected with a Arhan catheter and a TV-monitor visible to the patient have been employed. After a period of time variable from case to case, all patients of the "levator plasty" group prolonged the "alert-time" to a socially acceptable value, and all the patients of the "gracilis transplant" group obtained a complete fecal continence.