1A-S5-2

FECAL INCONTINENCE: BIOFEEDBACK TRAINING AND ITS EFFECT ON QUALITY OF LIFE (QOL) IN CHILDREN WITH ANORECTAL MALFORMATIONS

Weilin Wang, MD, Zhengwei Yuan, MD, Yuzuo Bai, MD

Department of Pediatric Surgery, The 2^nd Clinical College of China Medical University, Shenyang, China

Background/Purpose: The efficient treatment of postoperative fecal incontinence and its effect on quality of life (QOL) in children with anorectal malformations are limited to be understood. The purpose of this study is to design biofeedback training program and evaluates the QOL of those cases. Methods: 71 cases with anorectal malformations (high type 21 cases, intermediate type 17 and low type 33 cases) aged 8 – 16 years after surgery. He anal function was assessed by neuroelectrophysiology of the innervation of anal sphincter, radiographic defecography, isotope defecography, electromyography, anorectal manometry and clinical scoring. A biofeedback training program was designed. The QOL was investigated by somatic, social and psychological assessment. A scoring criterion of QOL was designed too. Results: 21 out of 71 cases complicated with fecal incontinence. A serial biofeedback training programs were designed on the basis of various mechanisms of fecal incontinence which included strengthening anorectal muscles, improving rectal sensation, reducing the time before anorectal sphincter contraction and resetting anorectal reflex. The results showed that all patients who received training program had got a satisfied anal function. The clinical scores increased from 3.7+1.0 before training to 5.7+0.5 after training in the group of intermediate and low types and from 2.3+1.0 to 4.6+0.5 in high type. The 7 out of 9 cases with postoperative constipation were significantly relieved after training. And the parameters representing anal function were improved greatly. The scores of QOL in patient group (9.4+3.7) were significantly lower than those of the controls (11.2+0.9, P<0.05). The scores of children with poor anal function (4.8+1.4) were significantly lower than those with good fecal control (10.9+1.2, P<0.01). Conclusions: The mechanism of fecal incontinence after that surgery is various. An efficient biofeedback training program should be designed on the mechanism of fecal dysfunction. The children with poor anal continence have poor QOL. Attention should be paid to rehabilitation of fecal continence after surgery. The bowel training, biofeedback therapy, somatic and psychological care and long-term follow-up are necessary to improve the QOL.