Incontinence: Biofeedback and other nonoperative modalities

Fecal incontinence is an unvoiced and stressful symptom that recognizes multiple etiologies. Some examples need to be treated medically by measures aimed at reducing stool frequency and improving stool consistency and that can be reinforced by biofeedback directed to improving motor and/or sensory functions. Biofeedback is a safe procedure and represents the first-line conservative therapy following failure of medical or supportive aid in fecal incontinence patients. Future placebo-controlled randomized studies are needed to better evaluate pelvic floor retraining in nonresponders to advice/education only and sensory retraining in incontinent patients. Outcomes should include standardized measures, validated quality of life questionnaires, and long-term assessment of therapeutic success.