Copyright © 2008 by Indian Society of Gastroenterology Original Article F ecal incontinence (FI) has significant social, medi cal and economic implications. FI may affect any age group, with significant impact on the quality of life of patients. 1 Common causes of fecal incontinence are con- genital anomalies of the anus, post partum tears or di- rect trauma to the anal sphincter. 2 Management of FI may be achieved either by non- surgical interventions such as pelvic floor muscle train- ing, sacral nerve stimulation and biofeedback or by sur- gical intervention aimed at reconstruction of a structur- ally defective anal sphincter or by creation of a neo- sphincter in the case of congenital absence of the native sphincter. 3,4 Biofeedback (BFB) trains patients with FI to contract their anal sphincters voluntarily, and is per- formed in an orderly stepwise manner over a period of several weeks. 5 BFB therapy may be performed either postoperatively to complement surgical reconstruction or as the sole mode of treatment especially, when damage to the anal sphincter is mild or if FI is predominantly due to pudendal neuropathy. 3 Most studies of BFB therapy have been in western patients. 6,7,8 The aim of our study was to evaluate short term outcome of BFB on continence, anorectal physio- logical parameters and quality of life in a group of pa- tients from Sri Lanka. Methods Between 1996 to 2007, fifty patients (median [range] age Biofeedback with and without surgery for fecal incontinence improves maximum squeeze pressure, saline retention capacity and quality of life B Nalinda L Munasinghe, M M Geethani Rathnayaka, Rajendran Parimalendran, Sumudu K Kumarage, Surendra de Zylva, M H Jayantha Ariyaratne, Kemal I Deen Department of Surgery, Faculty of Medicine, University of Kelaniya, Sri Lanka Introduction: Fecal incontinence (FI) impairs quality of life. We performed an audit of biofeed- back (BFB) in management of patients with FI. Methods: Fifty patients (median [range] age 30 [4-77] years; 28 men) who received BFB for median (range) of 15 weeks (4-28), either postoperatively (n=39), or as the sole treatment (n=11) were evaluated. Cleveland continence score (0-good, 20-poor), anorectal manometry param- eters, and patient satisfaction (assessed by Fecal Incontinence Quality of Life Scale [FIQLS]) were evaluated at baseline and after the BFB therapy in all patients. Results: Continence scores improved after intervention. In the surgery + BFB group, mean (SD) continence scores baseline vs. postsurgery + BFB (post-treatment) were 18.2 (3.9) vs. 6 (5.9; p<0.01). In the BFB alone group, scores were similar at baseline 11.7 (5.9) and 6.1 (5.2) post BFB (p=0.08). Maximum resting anal pressure (MRP) improved from preoperative 12.6 (9.8) mmHg to: vs. 21.1 (11.9) mmHg post-treatment (p<0.01). In patients who received BFB alone, MRP did not change significantly (pre vs post BFB 22.9 (11.7) mmHg vs. 29.6 (12.1) mmHg [p=0.08]). Maximal squeeze pressure improved significantly (preoperative vs. post-treat- ment: 46.3 (41.2) mmHg vs. 78.3 (33.9) mmHg [p<0.01]; pre vs. post BFB alone: 72.4 (34.8) mmHg vs. 114.5 (43.1) mmHg [p<0.01]). In 29 patients (19 surgery + BFB; 10 BFB alone), maximal tolerable volume in saline continence improved from baseline 47.9 (27.4) mL to 152.6 (87) mL after surgery + BFB (p<0.01); pre vs. post BFB: 98 mL (95.9) vs. 205 (134.3) p<0.02]. There was significant improvement in all parameters of FIQLS in both groups: lifestyle (p<0.02), coping/behavior (p<0.02), depression/self perception (p<0.02) and embarrassment (p<0.02). Conclusion: BFB therapy with or without surgical reconstruction of the damaged anal sphinc- ter improves maximum squeeze pressure, saline retention capacity, quality of life and is a use- ful first line treatment for fecal incontinence. Indian J Gastroenterol 2008 Jan-Feb; 27: 5-7