Effect of home biofeedback treatment in patients with fecal incontinence: a pilot study

BACKGROUND: Fecal incontinence is a common condition that markedly impairs quality of life. Anal biofeedback therapy is recommended as first-line treatment; however, its widespread use is limited by the need for repeated sessions, trained staff, high cost, and patient embarrassment, often resulting in poor adherence. This study aimed to evaluate the effectiveness of self-administered home-based biofeedback therapy and to determine factors associated with treatment success. METHODS: This prospective, single-center study included adult patients presenting with fecal incontinence. Disease severity and quality of life were assessed using the Wexner score, fecal incontinence severity index (FISI), and fecal incontinence quality of life (FIQOL) scale. Baseline evaluations included anal manometry, electromyography, perianal magnetic resonance imaging, or endoanal ultrasonography. All patients underwent a 3-month home-based anal biofeedback program. Primary outcomes were changes in Wexner, FISI, and FIQOL scores after treatment. RESULTS: Between September 2019 and January 2021, 24 patients were enrolled. The median Wexner score decreased significantly from 18 (4-20) to 6 (0-16) following therapy (p < 0.001). Similarly, the median FISI score improved from 48 (20-57) to 15 (0-45) (p < 0.001). Anal manometry demonstrated a significant increase in median maximum squeeze pressure from 20 (0-80) mmHg to 60 (17-96) mmHg (p < 0.001). Significant improvements were observed across all four FIQOL domains: lifestyle/coping, self-perception/sexuality, depression/anxiety, and embarrassment. Overall, 86% of patients showed improvement in Wexner scores, ranging from 11% to 100%, and 53% achieved a reduction greater than 50%. CONCLUSIONS: Self-administered home-based biofeedback therapy is an effective and practical treatment for fecal incontinence. Given its simplicity, accessibility, and cost-effectiveness, it represents a valuable alternative to conventional biofeedback therapy.