101 BIOFEEDBACK THERAPY FOR FECAL INCONTINENCE IN CHILDREN WITH MENINGOMYELOCELE

Abstract

Fourteen children with meningomyelocele and significant fecal soiling underwent anorectal manometry using a 3-balloon system connected to a physiograph. The ages of the children ranged from 5 to 17 years. On the basis of manometric criteria demonstrating some rectal sensation, 8 patients were treated with biofeedback conditioning. Children were taught to contract the external sphincter or nearby gluteal muscles in response to various volumes of rectal distention. Four of the 8 patients who received biofeedback had a good clinical response with either disappearance of soiling or a greater than 75% improvement in the frequency of soiling. Followup periods ranged from 3-12 months. The minimal criteria for successful treatment appeared to be: 1) Normal threshold of rectal sensation and 2) Ability to contract gluteal or related muscles. Responses to biofeedback could not be predicted by age, sex, surgery for spinal cord tethering, CSF shunts or bracing, but was best predicted by the anorectal manometric findings. On the basis of this experience, the following conclusions can be drawn: (1) Anorectal manometry is a rapid and inexpensive test to identify children with fecal soiling associated with meningomyelocele who may benefit from biofeedback conditioning. (2) Biofeedback is an effective therapeutic technique for fecal incontinence and should become an important part of bowel management programs for children with primary neurogenic sphincter dysfunction.

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