Biofeedback Training to Obtain Continence in Permanent Colostomy Experience of Two Centers G. REBOA, M.D.,* M. FRASCIO, M.D.,* R. ZANOLLA, M.D.,t G. PIIWO, M.D.,* E. BERTI RIBOLI, M.D,* Reboa G, Frascio M, Zanolla R, Pitto G, Berti Riboli E. Biofeedback training to obtain continence in permanent colostomy: experience of two centers. Dis Colon Rectum 1985;28:419-421. Biofeedback training is proposed as rehabilitative training for patients with permanent colostomies to help them achieve fecal continence. The results of a preliminary study of 18 patients are reported. [Key words: Colostomy; Fecal continence; Biofeedback] MILES' TECHNIQUE is the operation of choice for abdominoperineal resection of malignancy of the low rectum and anal canal, l The resulting abdominal colos- torny is not always well accepted, however, and is some- times even rejected by patients because of the psychosocial problems associated with fecal incontinence, z Several methods have been reported to enable patients to better control colostomy evacuations. 3-13 This is a report of an original study undertaken to improve fecal continence in patients with permanent colostomies by means of biofeedback training. Biofeedback is a psycho- physical conditioning process used by patients to control physiologic functions not normally perceived by means of visual and/or auditory signals.14 Several studies suggest that some physiologic processes previously considered to be under autonomic regulation can be brought under voluntary control using biofeed- back technique. 15-23 Biofeedback has been used to treat patients with fecal incontinence due to aging, surgical or traumatic injuries of the anus, or neurogenic lesions. 23-z8 Biofeedback as rehabilitative training for anal incontinence has also been used in patients with seriously compromised thresholds of sensitivity of the distal colon. The good results obtained in these patients encouraged us to apply the technique to patients with permanent colostomies, z9 Received for publication November 14, 1984. Address reprint requests to Dr. Reboa: Cattedra di Semeiotica Chi- rurgica, Universita degli Studi di Genova, Ospedale S. Martino, Via le Benedetto XV, 10, 16132, Genova, Italy. From the *Cattedra di Serneiotica Chirurgica, Universita degli Studi di Genova, Ospedale S. Martino, Genova, Italy, and the tServizio di Riabilitazione, Istituto Nazionale Turnori di Milano, Italy Materials and Methods Eighteen patients (ten males, eight females; mean age, 53.16 ___3.75) underwent colostomy biofeedback. All had abdominoperineal resections for cancers of the rectum at least two months before being treated. A plastic hour- glass-shaped device with three longitudinal passages for open-ended catheters to record intraluminal pressures and a balloon for volume stimulations of the colon are inserted through the colostomy opening (Fig. 1). The recording system consists of continuous, water-periused (2.5 ml/min flow rate) transducers (Statham P 231, Stat- ham Instruments, Oxford-California) connected to a pol- ygraph (EP 12 OTE BIOMEDICA, Florence, Italy) provided with an oscilloscope. Patients learn to recognize tracings corresponding to pressure values at stomas of their colostomies. By noting what maneuvers produce upward deflections on the trac- ings (psychologic concentration, deep breathing, and contractions of the abdominal wall muscles), patients learn to produce momentary increases in the stomal pres- sure. After biofeedback conditioning, volume stimuli are applied by inflating the balloon until a sensation of distention or fullness, similar to the arrival of feces or gas, is noted. Previous studies have shown that not only the rectum, but also the remaining colon is able to elicit the defeca- tion reflex when intraluminal distention is applied.3~ s~ Balloon distentions are performed out of the patients' view and at different levels proximal to the colostomies. Patients learn to identify the sensation and contract the abdominal muscles to produce adequate elevations of stomal pressure. 419