***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS Bowel dysfunction in patients with spinal cord injury often causes constipation , fecal incontinence , or a combination of both with a significant impact on quality of life .  Transanal irrigation improves bowel function in selected patients . However , controlled trials of different bowel management regimens are lacking . The aim of the present study was to compare transanal irrigation with conservative bowel management ( best supportive bowel care without irrigation ) . METHODS In a prospect i ve , r and omized , controlled , multicenter trial involving 5 specialized European spinal cord injury centers , 87 patients with spinal cord injury with neurogenic bowel dysfunction were r and omly assigned to either transanal irrigation ( 42 patients ) or conservative bowel management ( 45 patients ) for a 10-week trial period . RESULTS Comparing transanal irrigation with conservative bowel management at termination of the study , the mean ( SD ) scores were as follows : Clevel and Clinic constipation scoring system ( range , 0 - 30 , 30 = severe symptoms ) was 10.3 ( 4.4 ) versus 13.2 ( 3.4 ) ( P = .0016 ) , St. Mark 's fecal incontinence grading system ( range , 0 - 24 , 24 = severe symptoms ) was 5.0 ( 4.6 ) versus 7.3 ( 4.0 ) ( P = .015 ) , and the Neurogenic Bowel Dysfunction Score ( range , 0 - 47 , 47 = severe symptoms ) was 10.4 ( 6.8 ) versus 13.3 ( 6.4 ) ( P = .048 ) . The modified American Society of Colorectal Surgeon fecal incontinence scores ( for each subscale , range is 0 - 4 , 4 = high quality of life ) were : lifestyle 3.0 ( 0.7 ) versus 2.8 ( 0.8 ) ( P = .13 ) , coping/behavior 2.8 ( 0.8 ) versus 2.4 ( 0.7 ) ( P = .013 ) , depression/self perception 3.0 ( 0.8 ) versus 2.7 ( 0.8 ) ( P = .055 ) , and embarrassment 3.2 ( 0.8 ) versus 2.8 ( 0.9 ) ( P = .024 ) . CONCLUSIONS Compared with conservative bowel management , transanal irrigation improves constipation , fecal incontinence , and symptom-related quality of life This r and omized single‐blinded crossover study aim ed to investigate whether bilateral sacral nerve stimulation ( SNS ) is more efficient than unilateral stimulation for faecal incontinence ( FI ) Study design : R and omised controlled trial . Objectives : High- quality evidence for interventions in  bowel management ( BM )  after spinal cord injury ( SCI ) is lacking and BM programs are developed empirically . This r and omized , controlled trial compared usual care with a stepwise protocol based on earlier published work to examine whether systematic use of less invasive interventions could reduce the need for oral laxatives and invasive interventions such as manual evacuation , and improve BM outcomes in individuals with chronic SCI . Setting : United Kingdom . Methods : In all , 68 individuals were recruited ( 35 in intervention group ) , median age 47 years ( range 24–73 years ) , median duration of injury 16 years ( range 1–47 years ) . Bowel diaries were maintained for a maximum of 6 weeks while the intervention group followed a stepwise protocol design ed to test interventions singly and in combination . Measures of quality of life and preferences for different bowel care interventions were recorded . Results : The stepwise protocol did not improve BM outcomes ; fecal incontinence was more frequent ( P=0.04 ) ; the need for oral laxatives and invasive interventions was not reduced ( P=0.4 ) . Bowel care took consistently longer in the intervention group . Conclusions : The study findings support the need for manual evacuation in BM and provide evidence of acceptability of the technique to SCI individuals . For some individuals oral laxatives are an essential part of management . The results are in contrast with previous studies in younger sample s with shorter duration of injury Background We sought to compare two synthetic injectable bulking agents , with known efficacy ( PTQ ™ : a silicone bio material and Durasphere ® : pyrolytic carbon-coated beads ) , in the form of a r and omised clinical trial . Methods Circumferential injection of either agent was performed under local anesthesia and sedation as a day-case procedure . The primary outcome measure was the Wexner incontinence scale . Secondary measures were the short-form 36 ( SF-36 ) quality of life assessment and manometry ( maximum resting and squeeze pressures ) . Follow-up was at 6 weeks , 6 and 12 months . Results Thirty-five patients were r and omised , 17 to PTQ ® and 18 to Durasphere ® . Early closure of the trial occurred , due to the removal of the agent PTQ ® , from the Australian Pharmaceutical Benefits scheme . Wexner incontinence scores were significantly better than baseline , in both groups , at 6 weeks and 6 months ( P < 0.05 ) , although the improvements were not significant at 12 months . There was no significant improvement for either agent , from baseline , in mean SF-36 scores at any follow-up sessions . There was no significant difference between the two bulking agents , with regard to both Wexner and SF-36 scores , at any of the follow-up sessions . Complications occurred in one patient in the PTQ group ( perianal abscess ) and did not occur in any of the patients in the Durasphere group . Conclusions This trial appears to show that both synthetic agents PTQ ® and Durasphere ® are effective and safe , although long-term improvement is limited . In this trial , there appears to be no difference in efficacy between the two agents , over a 12-month follow-up period PURPOSE : This study was design ed to examine the role of adjuvant internal anal sphincter plication in women with neuropathic fecal incontinence undergoing pelvic floor repair . METHODS : We completed a r and omized trial with symptomatic and physiologic assessment before and after surgery . RESULTS : There was no symptomatic advantage of adding internal sphincter plication ; the mean improvement of functional score was 3.61±1.82 ( st and ard deviation;P<0.01 ) following pelvic floor repair alone compared with 2.80±1.66 ( st and ard deviation;P<0.01 ) when adjuvant internal anal sphincter plication was added . The addition of internal sphincter plication was associated with a significant fall in maximum anal resting and squeezing pressures ( P<0.01 ) . CONCLUSIONS : Addition of internal sphincter plication is not advised in women with neuropathic fecal incontinence treated by pelvic floor repair BACKGROUND & AIMS Some women with urge-predominant fecal incontinence ( FI ) have diarrhea-predominant irritable bowel syndrome and a stiffer and hypersensitive rectum . We evaluated the effects of the α2-adrenergic agonist clonidine on symptoms and anorectal functions in women with FI in a prospect i ve , placebo-controlled trial . METHODS We assessed bowel symptoms and anorectal functions ( anal pressures , rectal compliance , and sensation ) in 43 women ( age , 58 ± 2 y ) with urge-predominant FI , r and omly assigned to groups given oral clonidine ( 0.1 mg , twice daily ) or placebo for 4 weeks . Before and after administration of the medication , anal pressures were evaluated by manometry , and rectal compliance and sensation were measured using a barostat . Anal sphincter injury was evaluated by endoanal magnetic resonance imaging . Bowel symptoms were recorded in daily and weekly diaries . The primary end point was the FI and Constipation Assessment symptom severity score . RESULTS FI scores decreased from 9.1 ± 0.3 to 7.6 ± 0.5 among subjects given placebo and from 8.1 ± 0.4 to 6.5 ± 0.6 among patients given clonidine . Clonidine did not affect FI symptom severity , bowel symptoms ( stool consistency or frequency ) , anal pressures , rectal compliance , or sensation  compared with placebo . However , when baseline data were used to categorize subjects as those with or without diarrhea , clonidine reduced the proportion of loose stools in patients with diarrhea only ( P = .018 ) . Clonidine also reduced the proportion of days with FI in patients with diarrhea ( P = .0825 ) . CONCLUSIONS Overall , clonidine did not affect bowel symptoms , fecal continence , or anorectal functions , compared with placebo , in women with urge-predominant FI . Among patients with diarrhea , clonidine increased stool consistency , with a borderline significant improvement in fecal continence . Clinical Trials.gov , Number NCT00884832 Importance Robotic rectal cancer surgery is gaining popularity , but limited data are available regarding safety and efficacy . Objective To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer . Design , Setting , and Participants R and omized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery  among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries , including 40 surgeons . Recruitment of patients was from January 7 , 2011 , to September 30 , 2014 , follow-up was conducted at 30 days and 6 months , and final follow-up was on June 16 , 2015 . Interventions Patients were r and omized to robotic-assisted ( n = 237 ) or conventional ( n = 234 ) laparoscopic rectal cancer resection  , performed by either high ( upper rectum ) or low ( total rectum ) anterior resection or abdominoperineal resection ( rectum and perineum ) . Main Outcomes and Measures The primary outcome was conversion to open laparotomy . Secondary end points included intraoperative and postoperative complications , circumferential resection margin positivity ( CRM+ ) and other pathological outcomes , quality of life ( 36-Item Short Form Survey and 20-item Multidimensional Fatigue Inventory ) , bladder and sexual dysfunction ( International Prostate Symptom Score , International Index of Erectile Function , and Female Sexual Function Index ) , and oncological outcomes . Results Among 471 r and omized patients ( mean [ SD ] age , 64.9 [ 11.0 ] years ; 320 [ 67.9 % ] men ) , 466 ( 98.9 % ) completed the study . The overall rate of conversion to open laparotomy was 10.1 % : 19 of 236 patients ( 8.1 % ) in the robotic-assisted laparoscopic group and 28 of 230 patients ( 12.2 % ) in the conventional laparoscopic group ( unadjusted risk difference = 4.1 % [ 95 % CI , −1.4 % to 9.6 % ] ; adjusted odds ratio = 0.61 [ 95 % CI , 0.31 to 1.21 ] ; P = .16 ) . The overall CRM+ rate was 5.7 % ; CRM+ occurred in 14 ( 6.3 % ) of 224 patients in the conventional laparoscopic group and 12 ( 5.1 % ) of 235 patients in the robotic-assisted laparoscopic group ( unadjusted risk difference = 1.1 % [ 95 % CI , −3.1 % to 5.4 % ] ; adjusted odds ratio = 0.78 [ 95 % CI , 0.35 to 1.76 ] ; P = .56 ) . Of the other 8 reported prespecified secondary end points , including intraoperative complications , postoperative complications , plane of surgery , 30-day mortality , bladder dysfunction , and sexual dysfunction , none showed a statistically significant difference between groups . Conclusions and Relevance Among patients with rectal adenocarcinoma suitable for curative resection , robotic-assisted laparoscopic surgery , as compared with conventional laparoscopic surgery , did not significantly reduce the risk of conversion to open laparotomy . These findings suggest that robotic-assisted laparoscopic surgery , when performed by surgeons with varying experience with robotic surgery , does not confer an advantage in rectal cancer resection . Trial Registration is rct n.org Identifier : IS RCT Aim In a r and omized double‐blind study the therapeutic effect of a novel zinc – aluminium ointment was compared with placebo in patients with faecal incontinence OBJECTIVE to evaluate whether faecal incontinence can be improved by treatment of constipation in elderly patients with faecal incontinence associated with impairment of rectal emptying . DESIGN a prospect i ve r and omized study with a 2-month follow-up . SETTING five long-term care units . SUBJECTS 206 patients with daily faecal incontinence associated with chronic rectal emptying impairments such as faecal impaction received either a single osmotic laxative ( group I ) or an osmotic agent along with a rectal stimulant and weekly enemas ( group II ) . MEASUREMENTS episodes of faecal incont 
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In two separate RCTs , combination treatment of amplitude-modulated medium frequency stimulation and electromyography-biofeedback ( EMG-BF ) , was noted to be superior to EMG-BF and low-frequency electrical stimulation alone .
Combination of non-surgical treatments such as BF with sphincteroplasty significantly improved continence scores compared to sphincteroplasty alone .
Surgical treatments were associated with higher rates of serious adverse events compared to non-surgical interventions .
Conclusions : The current evidence has not identified significant differences between treatments for FI , and where differences were identified , the results were contradictory between RCTs