Validation of a Multimodal Algorithm for the Treatment of Fecal Incontinence

Hospital de Mataró

Status: Unknown

Conditions: Fecal Incontinence

Treatments: Device: Biofeedback+Tibial Neuromodulation+Kegel; Combination Product: Biofeedback+Electrostimulation+Kegel; Combination Product: Biofeedback+Kegel

Study type: Interventional

Funder types: Other

Identifiers

NCT05026970

16/19

Details and patient eligibility

About

Thisi is a pragmatical clinical trial with the main aim of main aim of evaluating the effectiveness of the combination of treatments for the management of fecal incontinence (FI), on profiles of patients with IF based on pathophysiological criteria, measuring physiological, clinical and quality of life outputs.

Secondary:

1. Evaluate the presence of SIBO, gluten-sensitive enteropathy, malabsorption of bile salts or sugars in patients with Bristol stools ≥5 that condition the fecal continuity.
2. Effect of change in fecal consistency on IF symptoms.
3. To evaluate the effect of the combination of treatments on anorectal physiology and neurophysiology (motor and sensory), clinical severity and quality of life.
4. Evaluate the persistence of the treatments to the three months of end of the same.

Full description

FI is a very prevalent condition in community dwelling women. We have previously studied the efectivenes of four treatments in women with FI as well as the effect on the anorectal physiology and neurophysiology. All treatments improved clinical symptoms of FI but there were no statistical differences between the treatments, that were Kegel exercises (K), biofeedback (BF)+K, electrostimulation (ES)+K, and transcutaneous neuromodulation (tNM)+K. With this prevoous study we have a clearer idea of the anorectal physiology which should allow to select patients for given treatments.

For the present study we try to validate a multimodal algorithm to treat FI, taking into account the underlying pahtophysiology.

It will have 2 differentiated stages:

Stage 1: Patients with loose stools (Bristol >5): they will be studied to determine the cause of the diahrrea (mainly food intolerances) and treated accordingly. If FI symptoms remain, patients will pass to:

Stage 2: Patients with Bristol<6 anf FI symptoms. They will be adressed to 3 combinations of treatments according to the pathophysiology that explain the symptoms, which will be:

BF+ES+K: those patients with direct sphincter damage BF+tNM+K: patients with external anal sphincter dennervation and/or colonic motility disorders.

BF alones: patients with FI mainly explained by a bad control of the pelvic floor function (akinesia/dyssynergia).

All patients will be studied with High Resolution Anorectal Manometry, PNTML, endoanal unltrasonography. Clinical severity and QoL with dedicated intruments or questionnaires.

If after 1sr stage, if so, patients have a clinical severity of Cleveland<4 they will be followed up at 3 months with K, studued again their clinical severity and QoL.

After 2nd stage, if so, 3-month of targeted treatment will be performed, and reevaluated with HRAM, PNTML and clinical questionnaires. They will be followed up at 3 monts with only K to study the persistance of the treatments.

Enrollment: 150 estimated patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• FI episodes at least 6 months before
• FI episodes each month
• No other treatment the year before
• Able to self-administer treatments

Exclusion criteria

• Pregnancy
• If, to investigators criteria, patient will fail to administer the tratmetns properly, due to physical or psychic conditions

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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150 participants in 3 patient groups

Biofeedback+Electrostimulation+Kegel

Active Comparator group

Description:

Biofeedback (3 sessions) Electrostimulation (12 weeks daily treatment) Kegel exercises (twice daily)

Treatment:

Combination Product: Biofeedback+Kegel

Device: Biofeedback+Tibial Neuromodulation+Kegel

Biofeedback+Tibial Neuromodulation+Kegel

Active Comparator group

Description:

Biofeedback (3 sessions) Transcutaneous Neuromodulation (12 weeks daily treatment) Kegel exercises (twice daily)

Treatment:

Combination Product: Biofeedback+Kegel

Combination Product: Biofeedback+Electrostimulation+Kegel

Biofeedback+Kegel

Active Comparator group

Description:

Biofeedback (6 sessions) Kegel exercises (twice daily)

Treatment:

Combination Product: Biofeedback+Electrostimulation+Kegel

Device: Biofeedback+Tibial Neuromodulation+Kegel