Retrospective Real-world Analysis of Home Electrical Stimulation with Voluntary Muscle Training in Urge vs. Passive Fecal Incontinence Phenotypes

Abstract Introduction Fecal incontinence (FI) characterized by uncontrolled passage of fecal material is a relatively common disorder. The Rome IV Criteria for Disorders of Gut-Brain Interaction (DGBI) define FI as a recurrent uncontrolled passage of fecal material in an individual with a developmental age of at least 4 years. The therapy for fecal incontinence comes with substantial number of hindrances and often result in disappointing results for patients. Therefore it should be individualized based on symptom presentation. Home electrical stimulation (HES) is a highly personalized method of therapy and when combined with voluntary sphincter training it could lead to significant improvement of the patient symptoms. However, there is a significant difference of protocols and device settings between these studies with lack of known evidence in real world clinical setting. Methods This a retrospective single center study based on real world data. Patients who had clinically distinctive urge or passive incontinence were considered for the study. The treatment duration was 12 weeks and patients used the manufacturer setting for stress incontinence. After the initial examination with 3D High definition anorectal manometry and filling the Wexner incontinence score questionary patients were thoroughly instructed about the use of the home stimulation device. The treatment protocol required to train once daily for 20 min six times a week. The control visit was performed 12 weeks after the initial visit with identical clinical evaluation protocol. Results Total number of evaluated patients was nineteen (19), ten (10) with passive and nine (9) wit urge incontinence . Both groups showed the improvement of sphincter function. These were significantly more prominent within the urge incontinence group. The total average increase in sphincter rest mean pressure was 22.53%, total average increase in sphincter rest maximum pressure was 25.69%, and total average increase during voluntary maximum pressure 36.13%. There overall improvement of Wexner score was significant (15 vs. 9 points, pre vs post therapy). Conclusion The home electric stimulation combined with voluntary sphincter training is effective in both clinical types of fecal incontinence, but substantially higher in urge incontinence. Further randomized studies should evaluate the additive effect of voluntary muscle contraction on the overall effect of therapy.