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This literature review explores the role of biofeedback therapy (BFT) in managing functional fecal incontinence (FFI) in children - a common condition with a substantial impact on the quality of life. FFI diagnosis relies primarily on medical history and thorough physical examination and is categorized by the Rome IV criteria into functional constipation (FC) and functional nonretentive fecal incontinence (FNRFI). Treatment options for FFI remain limited, particularly for FNRFI. BFT employs electronic or mechanical devices, such as rectal probes or surface electrodes, to provide real-time feedback on muscle activity and rectal pressure. This feedback allows patients to better understand and control their pelvic floor muscles, improving coordination between contraction during stool retention and relaxation during defecation. It also plays a role in rectal sensory awareness, enabling patients to respond appropriately to the urge to defecate. BFT has been considered an option in refractory cases, although evidence supporting its routine use is still emerging. We conducted a comprehensive literature search focusing on studies from the past 24 years that evaluated BFT for pediatric FFI. Five relevant studies were identified and analyzed, each utilizing BFT in combination with various treatment modalities. Two studies, both randomized controlled trials (RCT) and with the largest sample, focused on the treatment of FNRFI, both concluding that BFT should be used in FNRFI refractory to conventional treatment. Another two studies, one RCT and a retrospective study, focused on patients with FC. The first did not show any additional value in the use of BFT, while the second showed positive results. Comparing both studies, they had very different methodologies and treatment plans, but besides these results, in both studies, they concluded that when selecting a treatment plan for a child with FFI, an alternative or additional treatment with BFT should be considered. Finally, the last study, a quasi-experimental study, did not differentiate between FC or FNRFI and compared the use of BFT to percutaneous tibial nerve stimulation (PTNS). Although they showed that there were slightly better results when using PTNS, they concluded that both PTNS and BFT are effective modalities in treating children with FFI in addition to conventional treatment. Overall, BFT showed positive outcomes, with no safety issues reported. BFT appears to be a useful, non-invasive option for pediatric FFI, both FC and FNRFI, especially in cases unresponsive to conventional therapies. When used in a tailored, multimodal approach, BFT holds the potential to improve continence and quality of life in children with this challenging condition, and given that 15% of children with FFI, specifically FNRFI, continue to experience symptoms into adulthood, it is crucial to consider these treatment options early to potentially reduce this rate. Besides this, more research is needed to conclude the long-term effects and to establish standardized pediatric rehabilitation protocols.
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http://dx.doi.org/10.7759/cureus.74295 | DOI Listing |
J Electromyogr Kinesiol
December 2024
Department of Obstetrical and Gynecological Pathology, Division of General Surgery and Medical Surgical Specialities, University of Catania, Catania, Italy. Electronic address:
Objective: To investigate the impact of mediolateral episiotomy on the innervation zones of the External Anal Sphincter (EAS) in the absence and presence of direct muscular injury.
Methods: This case series examined four primiparous women, including three who underwent vaginal deliveries with mediolateral episiotomy and one cesarean section case for reference. Pre- and post-delivery assessments utilized surface electromyography (sEMG) and endoanal ultrasound to evaluate changes in the EAS's innervation zones and obstetrical EAS injuries, alongside the Wexner score for fecal incontinence.
Cureus
November 2024
Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT.
This literature review explores the role of biofeedback therapy (BFT) in managing functional fecal incontinence (FFI) in children - a common condition with a substantial impact on the quality of life. FFI diagnosis relies primarily on medical history and thorough physical examination and is categorized by the Rome IV criteria into functional constipation (FC) and functional nonretentive fecal incontinence (FNRFI). Treatment options for FFI remain limited, particularly for FNRFI.
View Article and Find Full Text PDFCureus
November 2024
General Surgery, Lady Reading Hospital Medical Teaching Institution (MTI), Peshawar, PAK.
Introduction An anal fissure is marked by a longitudinal tear in the mucosal lining of the lower anal canal, causing painful defecation and mild anal bleeding. The classical triad includes an anal ulcer, a sentinel tag, and a hypertrophic papilla. This study investigates the frequency of fecal incontinence in patients with anal fissure undergoing closed internal sphincterotomy, offering recent insights for treatment recommendations.
View Article and Find Full Text PDFCureus
November 2024
Neurology, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suárez", Mexico City, MEX.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis stands as the most prevalent form of autoimmune encephalitis, primarily affecting young patients and exhibiting a higher incidence among females. Patients frequently present with psychiatric symptoms or cognitive impairments such as speech disturbances, decreased level of consciousness, autonomic dysfunction, as well as seizures, dyskinesias, and catatonia due to overactivation of extrasynaptic NMDA receptors. To date, there is no gold standard for the diagnosis of catatonia; however, a few rating scales exist to measure this phenomenon, with the Bush Francis Catatonia Rating Scale being the most commonly used due to its validity, reliability, and ease of application.
View Article and Find Full Text PDFZhonghua Wei Chang Wai Ke Za Zhi
December 2024
Department of Colorectal Surgery, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing210029, China.
Horseshoe anal fistula is one of the most challenging subtypes of complex anal fistulas, closely related to the failure of anal fistula surgery and postoperative recurrence. Accurate preoperative assessment, correct classification, and appropriate surgical plans are crucial for improving treatment efficacy. This article primarily explores the clinical classification of horseshoe anal fistulas and the applicability of mainstream surgical techniques in different types of horseshoe anal fistulas, focusing on their cure rates, recurrence rates, and fecal continence, to assist surgeons to make reasonable surgical plans when treating horseshoe anal fistulas.
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