Biofeedback in patients with ileoanal pouch dysfunction: a specialist centre experience.

OBJECTIVES: To report outcomes following biofeedback for functional problems associated with an ileoanal pouch. Incontinence and evacuatory disorders associated with the ileoanal pouch can be particularly problematic and difficult to treat using conventional therapies. Biofeedback therapy is a behavioural treatment that offers a non-surgical approach as an alternative or adjunct for patients. MATERIALS AND METHODS: This was a retrospective single centre study. We reviewed the notes of all patients attending for biofeedback at our institution between January 2012 and October 2017 and identified all those that did so for ileoanal pouch related problems. We recorded patient reported subjective improvements following biofeedback. The validated International Consultation on Incontinence Questionnaire was used to assess improvement in incontinent symptoms and the evacuatory disorder questionnaire was used to assess improvement in evacuatory disorders. RESULTS: Twenty-six patients with ileoanal pouch related problems underwent biofeedback. Based on patients' feedback at next clinical encounter following biofeedback, nine reported much improvement, 11 reported some improvement and six reported no improvement. In the group treated for incontinence, quality of life improved significantly from a median pre-treatment score of 80 to a post-treatment score of 41 (p = .01). Biofeedback reduced pain, bloating straining and laxative use in patients with evacuatory disorders. CONCLUSIONS: Biofeedback may be associated with significant improvement in quality of life as well as possible improvements in symptoms related to both incontinence and evacuatory disorders. It is probably an underused service. Further larger prospective studies are required to properly assess the efficacy of biofeedback in ileoanal pouch related dysfunction.

Factors Associated With Efficacy of Nurse-led Bowel Training of Patients With Chronic Constipation.

BACKGROUND & AIMS: It is not clear whether nurse-led bowel training (NBT), an individually tailored biofeedback strategy designed to improve the physiological process of defecation by operant conditioning and trial and error learning, is effective for patients with chronic constipation. We assessed the ability of NBT to reduce symptoms and increase quality of life in patients with constipation at a large tertiary medical center. METHODS: We performed a retrospective analysis of data from 347 patients (median age, 50 years) who underwent a median 3 sessions of NBT for chronic constipation from January 2011 through December 2013 at St Marks Hospital in the United Kingdom. The NBT comprised a combination of sensory retraining, pelvic floor conditioning, and advice on diet and toileting behavior. Data on patient demographics (age, sex, type of constipation) were collected alongside their assessments of constipation, which were based on Patient Assessment of Constipation Quality of Life (PAC-QoL) and patient satisfaction scores. We performed binary logistic regression analysis. Each variable was tested first at the univariate level; those with significance (P < .10) were included in a multivariate model. RESULTS: At the end of NBT, 62.5% of the patients (217/347) reported reduced symptoms, and 40.2% of the patients (41/102) reported a reduction of at least 1 point on the PAC-QoL score. The mean PAC-QoL scores before and after NBT were 2.42 and 1.41, respectively (P = .001). Multivariate analysis demonstrated that increasing age (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.02-2.87; P = .042), greater number of sessions (OR, 4.14; 95% CI, 2.09-8.20; P < .001), and non-irrigation (OR, 4.39; 95% CI, 1.89-10.19; P = .001) were independent predictors of patient satisfaction. CONCLUSIONS: Data collected immediately after patients with chronic constipation received NBT indicate that it is an effective treatment for most patients. Older patients with dyssynergic defecation benefit most from at least 4 sessions.

Managing passive incontinence and incomplete evacuation.

Both passive faecal incontinence and evacuation difficulty are distressing and demoralising conditions, resulting in physical and psychological problems including social restrictions, loss of self-esteem, altered body image and loss of skin integrity. Conservative management and biofeedback therapy has been shown to help most patients with faecal incontinence and evacuation difficulty by creating a manageable situation that can significantly improve quality of life. However, some patients may not improve their symptoms and require alternative measures. This article reports an audit of the use of the Qufora mini irrigation system in 50 patients (48 female, 2 male) with passive faecal incontinence and/or evacuation difficulty who had failed to respond to conventional biofeedback. Seventy percent found the irrigation comfortable and 74% rated the system as good or acceptable. Two-thirds believed symptoms were improved and would wish to continue using the system. Prospective studies are needed to confirm which patients are most suitable and respond well to the irrigation.

Using biofeedback to treat constipation, faecal incontinence and other bowel disorders.

Biofeedback is a behavioural therapy used to treat people with bowel dysfunction, such as constipation or faecal incontinence, who do not respond to standard treatment. This article highlights how biofeedback therapy is used to treat these problems and improve patients' quality of life.

Constipation, treatment and biofeedback therapy.

Constipation is commonly encountered by the community nurse, particularly in older people. A comprehensive assessment is required prior to treatment, to exclude potential pathologies such as a bowel cancer. There are many potential causes of constipation, such as poor diet or use of opioid analgesia. This can guide the nurse to a potential treatment, for example to include more fibre in the diet or to possibly change the analgesia used. However if these and/or other therapies fail, biofeedback therapy offers a non-surgical option. Biofeedback therapy includes patient education, retraining of the bowels and muscles, behavioural therapies and psychological support.

Managing a colostomy or ileostomy in community nursing practice.

After stoma formation the patient should be independent with their own stoma care. However, with emphasis being placed on community nurses for ongoing aftercare of ostomates: Skingley (2004) has asserted that many community nurses did not feel confident undertaking stoma care. This article is ideally placed for the community nurses to obtain a broad overview of some of the key points pertaining to stoma care. The article looks at care of ostomates and ileostomates in relation to available appliances and also discusses dietary recommendations.

Prevention and management of constipation in adults.

Constipation is a common, often chronic, condition that is a health concern for providers of care. The condition can be distressing and although seldom life-threatening can lead to patient discomfort and debilitating effects on patients' quality of life. Initial management of chronic constipation should include lifestyle changes and increased fibre and fluids. More active interventions include the use of laxatives and other medications, irrigation and biofeedback therapy. Some patients may require surgery. This article provides an overview of the strategies used to prevent constipation in adults as well as the possible treatment options available.

A feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care.

OBJECTIVE: To assess preliminary effects of a program of transcutaneous posterior tibial nerve stimulation (TPTNS) on lower urinary tract symptoms and number of episodes of urinary and fecal incontinence in older adults in residential care homes and the feasibility of a full-scale randomized trial. DESIGN: Pilot randomized single-blind, placebo-controlled trial. SETTING: Seven residential care homes and 3 sheltered accommodation complexes in the United Kingdom. PARTICIPANTS: Thirty care home residents aged 65 and older with urinary or bowel symptoms and/or incontinence. INTERVENTIONS: Twelve 30-minute sessions of TPTNS or sham stimulation (placebo). MEASUREMENTS: Lower urinary tract symptoms using American Urological Society Symptom Index, urinary incontinence using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), postvoid residual urine volumes using portable bladder scanning, bowel symptoms and fecal incontinence using selected ICIQ questions. RESULTS: Total American Urological Society Symptom Index scores improved, showing a median reduction of 7 (interquartile range [IQR] -8 to -3) in the TPTNS group and a median increase in the sham stimulation (placebo) group of 1 (IQR -1 to 4) (Mann-Whitney U 16.5000, Z -3.742, P < .001). Total ICIQ-SF scores improved by a median of 2 (IQR -6 to 0) in the TPTNS group and 0 points (IQR -3 to 3) in the sham stimulation group (Mann-Whitney U 65.000, Z -1.508, P = .132). Significant reduction was found in postvoid residual urine of 55 mL in the TPTNS group (t = -2.215, df 11.338, P = .048). Bowel urgency improved in 27% of the TPTNS group compared with 8% of the sham group (χ(2) 2.395, df 2, P > .302), fecal leakage improved in 47% of the TPTNS group compared with 23% of the sham group (χ(2) 4.480, df 2, P > .106); however, these differences were not significant. No adverse effects were reported by older adults or care staff. CONCLUSION: TPTNS is safe and acceptable with evidence of potential benefit for bladder and bowel dysfunction in older male and female residents of care homes. Data support the feasibility of a substantive trial of TPTNS in this population.