Biofeedback for bowel control
This is an internationally renowned nurse-led service. A team of specialists manage patients with a range of functional gastrointestinal disorders including faecal incontinence and constipation as the two largest groups. Direct referrals are taken from both secondary and primary care. Relevant tests are pre-ordered according to the patients’ individual bowel and pelvic floor dysfunction.
Biofeedback is widely regarded as a first line non invasive treatment in constipation, evacuatory disorders and faecal incontinence (1). NICE have also identified the “positive effect” of Biofeedback on IBS patients. Studies have shown that Biofeedback for bowel dysfunction is effective in 70-80% of patients with the majority of these maintaining long term benefits (2). Biofeedback is a behavioural approach to which there are no side effects, it is non-invasive and offers a non-surgical approach as an alternative for patients with bowel dysfunction. A recent audit of 150 patients at St Marks biofeedback department showed 84% of patients improved their symptoms. The patients rating of change to their bowel symptoms was a median of 3/5 and rating of satisfaction with the treatment was a median of 8/10.
The nurses and physiotherapists work within a multidisciplinary team and patients can be discussed with, or referred to a gastroenterologist, colorectal surgeon, counsellor, psychologist, psychotherapist, dietician and other nurse specialists if indicated. Regular clinical supervision and audit of case decisions is undertaken by the Nurse Consultant and a Consultant Gastroenterologist. However, we do expect that referring doctors have considered possible bowel pathology and investigated patients appropriately prior to referral for biofeedback.
Patients are posted a symptom questionnaire to complete and bring to the first appointment. Biofeedback offers patients an individualised package of care: Initially, each patient will have a one hour assessment. Thereafter, patients are seen approximately for 4-5 appointments at 4-6 weekly intervals with ongoing care from the same therapist. The team work flexible hours in order to accommodate most patients.
The team consist of:
Nurse Consultant Professor Christine Norton
Lead Nurse Brigitte Collins
Clinical Nurse Specialist Lorraine O'Brien
Clinical Nurse Specialist Elissa Bradshaw
Clinical Nurse Specialist Anna Swatton
Clinical Biofeedback/Physiotherapist Specialist Patricia Evans
REFERENCES
(1) National Institute of Clinical Excellence. Management of faecal incontinence in adults: CG 49. London: NICE; 2007.
(4) Rao, S.S.C. (2008) Disorders of the Pelvic Floor and Anorectum. Gastorenterology Clinic of North America. 37(3): 493-506.
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