Lack of improvement in anorectal manometry parameters after implementation of a pelvic floor/anal sphincter biofeedback in persons with motor-incomplete spinal cord injury

Mark M Aloysius; Mark A Korsten; Miroslav Radulovic; Kamaldeep Singh; Brian L Lyons; Tradd Cummings; Joshua Hobson; Sandeep Kahal; Ann M Spungen; William A Bauman

doi:10.1111/nmo.14667

Lack of improvement in anorectal manometry parameters after implementation of a pelvic floor/anal sphincter biofeedback in persons with motor-incomplete spinal cord injury

Neurogastroenterol Motil. 2023 Nov;35(11):e14667. doi: 10.1111/nmo.14667. Epub 2023 Sep 25.

Authors

Mark M Aloysius^{1

2}, Mark A Korsten^{3

4

5

6}, Miroslav Radulovic^{3

4

5

6}, Kamaldeep Singh⁷, Brian L Lyons³, Tradd Cummings⁸, Joshua Hobson³, Sandeep Kahal⁹, Ann M Spungen^{3

5

6}, William A Bauman^{3

4

5

6}

Affiliations

¹ Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA.
² Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.
³ National Center for Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York, USA.
⁴ Medical Service, James J Peters VA Medical Center, Bronx, New York, USA.
⁵ Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁶ Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁷ Department of Medicine, College of Medicine, Tucson, Arizona, USA.
⁸ Bristol Myer's Squibb, Stroudsburg, Pennsylvania, USA.
⁹ Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

PMID: 37743783
DOI: 10.1111/nmo.14667

Abstract

Background: Effect of biofeedback on improving anorectal manometric parameters in incomplete spinal cord injury is unknown. A short-term biofeedback program investigated any effect on anorectal manometric parameters without correlation to bowel symptoms.

Methods: This prospective uncontrolled interventional study comprised three study subject groups, Group 1: sensory/motor-complete American Spinal Injury Association Impairment Scale (AIS) A SCI (n = 13); Group 2 (biofeedback group): sensory incomplete AIS B SCI (n = 17) (n = 3), and motor-incomplete AIS C SCI (n = 8), and AIS D SCI (n = 6); and Group 3: able-bodied (AB) controls (n = 12). High-resolution anorectal manometry (HR-ARM) was applied to establish baseline characteristics in all subjects for anorectal pressure, volume, length of pressure zones, and duration of sphincter squeeze pressure. SCI participants with motor-incomplete SCI were enrolled in pelvic floor/anal sphincter bowel biofeedback training (2 × 6-week training periods comprised of two training sessions per week for 30-45 min per session). HR-ARM was also performed after each of the 6-week periods of biofeedback training.

Results: Compared to motor-complete or motor-incomplete SCI participants, AB subjects had higher mean intra-rectal pressure, maximal sphincteric pressure, residual anal pressure, recto-anal pressure gradient, and duration of squeeze (p < 0.05 for each of the endpoints). No significant difference was evident at baseline between the motor-complete and motor-incomplete SCI groups. In motor-incomplete SCI subjects, the pelvic floor/anal sphincter biofeedback protocol failed to improve HR-ARM parameters.

Conclusion: Biofeedback training program did not improve anal manometric parameters in subjects with motor-incomplete or sensory-incomplete SCI. Biofeedback did not change physiology, and its effects on symptoms are unknown.

Inferences: Utility of biofeedback is limited in patients with incomplete spinal cord injury in terms of improving HR-ARM parameters.

Keywords: biofeedback; high resolution anorectal manometry; spinal cord injury; supraconal lesions.

MeSH terms

Anal Canal
Biofeedback, Psychology / methods
Fecal Incontinence* / etiology
Fecal Incontinence* / therapy
Humans
Manometry
Pelvic Floor
Prospective Studies
Rectum
Spinal Cord Injuries*