***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 
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    Input: Background : Prevalence studies of faecal incontinence in the general population are rare and the impact of faecal incontinence on quality of life has not been previously addressed . Aims : To establish the prevalence of faecal incontinence in adults in terms of frequency of leakage , degree of soiling , and level of impact on quality of life . Methods : In a cross sectional postal survey , 15 904 adults aged 40 years or more ( excluding residents of nursing and residential homes ) were selected r and omly by household from the Leicestershire Health Authority patient register . Participants were asked to complete a confidential health question naire . Major faecal incontinence was defined as soiling of underwear or worse with a frequency of several times a month or more . Respondents were also asked if bowel symptoms had an impact on their quality of life . Results : From a total sample of 10 116 respondents , 1.4 % reported major faecal incontinence and 0.7 % major faecal incontinence with bowel symptoms that had an impact on quality of life . Major faecal incontinence was significantly associated with a lot of impact on quality of life ( odds ratio 12.4 , 95 % confidence interval 7.5–20.6 ) . Incontinence was more prevalent and more severe in older people but there was no significant difference between men and women . Conclusions : This study has confirmed that faecal incontinence is a fairly common symptom , particularly in older people . Faecal incontinence in men has received little attention in the past and the results from this study indicate that it is as much of a problem in men as it is in women while the level of unmet need in this group is high . Estimates of need for health care for this symptom should be multidimensional and assess both the severity of symptoms and the impact it has on quality of life In order to evaluate the efficacy of  biofeedback  for childhood encopresis , 50 children with encopresis were prospect ively studied and r and omized to receive biofeedback ( B ) or mineral oil therapy ( M ) . Specificity of  biofeedback  was also evaluated by comparing outcomes of both regimens in children with normal ( n = 32 ) and abnormal ( n = 18 ) defecation patterns . Using a single blinded design , there were no significant differences in clinical outcomes between the 24 children receiving B and the 26 children receiving M at 3 , 6 , and 12 months . However , at 12 months six of nine children with abnormal defecation patterns were in remission or markedly improved after receiving B , compared to only three of nine children receiving M. In contrast , children with normal patterns appeared to respond better to M than did those receiving B ( 71 vs. 40 % at 12 months ) . Biofeedback appears to warrant further evaluation in children with encopresis and abnormal defecation patterns The efficacy of biofeedback treatment on faecal incontinence and anorectal function was evaluated in eight patients with faecal incontinence treated with biofeedback training and medical therapy .  Outcome and anorectal function were compared with nine faecal incontinent patients who received medical therapy alone . Three month follow up showed that 50 % of patients in the biofeedback plus conventional treatment group and 56 % of those treated conventionally only had improved . One year follow up showed that 13 % in the biofeedback group were free of soiling and an additional 25 % had improved . The results were similar in the conventionally treated group--11 % were free of soiling and an additional 44 % improved . Anal pressures at rest and squeeze , the rectal distension volume that induced sustained inhibition of both the external and internal anal sphincter , and continence to rectally infused saline were significantly reduced in both groups of patients compared with controls ( p less than 0.05 ) . Biofeedback treatment had no effect on these abnormal anorectal functions in either patients who improved or those who did not . The improvement in faecal incontinence was probably due to medical intervention or regression of symptoms with time , or both , and not the result of biofeedback training AIMS : To evaluate biofeedback training in children with encopresis and the effect on psychosocial function . DESIGN : Prospect i ve controlled r and omised study . PATIENT INTERVENTIONS : A multimodal treatment of six weeks . Children were r and omised into two groups . Each group received dietary and toilet advice , enemas , oral laxatives , and anorectal manometry . One group also received five biofeedback training sessions . MAIN OUTCOME MEASURES : Successful treatment was defined as less than two episodes of encopresis , regular bowel movements , and no laxatives . Psychosocial function after treatment was assessed using the Child Behaviour Checklist . RESULTS : Children given laxatives and biofeedback training had higher success rates than those who received laxatives alone ( 39 % v 19 % ) at the end of the intervention period . At 12 and 18 months , however , approximately 50 % of children in each group were successfully treated . Abnormal behaviour scores were initially observed in 35 % of children . Most children had improved behaviour scores six months after treatment . Children with an initial abnormal behaviour score who were successfully treated had a significant improvement in their behavioural profiles . CONCLUSIONS : Biofeedback training had no additional effect on the success rate or behaviour scores . Psychosocial problems are present in a subgroup of children with encopresis . The relation between successful treatment and improvement in behavioural function supports the idea that encopresis has an aetiological role in the occurrence and maintenance of behavioural problems in children with encopresis BACKGROUND Because abnormal defaecation dynamics , which can be modified by biofeedback , are considered to be the underlying problem in constipation , biofeedback training may be a useful treatment for constipation . This treatment has mainly been studied in uncontrolled trials . We evaluated defaecation dynamics and clinical outcome in chronically constipated children in a r and omised study comparing conventional treatment and conventional treatment with biofeedback training . METHODS Patients , 5 to 16 years old , were referred to the Academic Medical Center in Amsterdam by general practitioners , school doctors , paediatricians , and psychiatrists . They had to fulfil at least two of four criteria for paediatric constipation and were included if they had been treated medically for at least one month before r and omisation . Patients had a medical history , abdominal and rectal examination , and anorectal manometry at the start and end of the 6-week intervention period . The conventional group received laxative treatment with additional dietary advice , toilet training , and maintenance of a diary of bowel habits . The biofeedback group received the same conventional treatment and additionally five biofeedback training sessions . During the first 3 weeks , patients visited the outpatient clinic weekly ; two subsequent visits were twice monthly . FINDINGS 94 patients were r and omised to conventional treatment ( CT ) and 98 to conventional treatment with additional biofeedback training ( CT+BF ) .  Normal defaecation dynamics increased in the CT group from 41 % to 52 % ( not significant ) and in the CT+BF group from 38 % to 86 % ( p = 0.001 ) . At 6 weeks , more patients in the CT+BF group showed normal defaecation dynamics , compared to the CT group ( p < 0.001 ) . This result was unaltered by controlling for baseline status in a logistic regression model . At 1 year , successful treatment ( defaecation frequency > or = 3/week , soiling and /or encopresis < 2/month , and no laxatives ) was accomplished in 59 % of the CT and 50 % of the CT+BF group ( p = 0.24 ) . The results were maintained after 1 1/2 years follow-up . No association was found between achievement of normal defaecation dynamics and clinical outcome . INTERPRETATION Additional biofeedback training compared to conventional therapy did not result in higher success rates in chronically constipated children . Furthermore , achievement of normal defaecation dynamics was not associated with success : abnormal defaecation dynamics seem not to play a crucial role in the pathogenesis of childhood constipation .  Intensive conventional laxative treatment should remain the first choice in chronically constipated children PURPOSE : This study was design ed to compare prospect ively the effects of augmented biofeedback with those of sensory biofeedback alone on fecal incontinence and anorectal manometry after obstetric trauma . METHODS : A consecutive cohort of 40 females with impaired fecal continence after obstetric anal sphincter injury were recruited from a dedicated perineal clinic . Patients were r and omly assigned to receive either augmented biofeedback or sensory biofeedback alone . All patients were assessed before and after twelve weeks of biofeedback training , using a fecal continence question naire and anorectal manometry . RESULTS : Thirty-nine of 40 females recruited completed the study .  Continence scores improved in both treatment groups , but the results were better for those who received augmented biofeedback .  Anorectal manometry was unchanged by sensory biofeedback , whereas anal resting and squeeze pressures increased with augmented biofeedback . No change in anal vector symmetry was observed in either group . CONCLUSION : Augmented biofeedback training is superior to sensory biofeedback alone in the treatment of impaired fecal continence after obstetric trauma Compared the additive benefits of laxative , behavior , and biofeedback treatments for  encopresis  , while attempting to identify treatment mechanisms and predictors of treatment outcome . 44 encopretic children , ages 6 - 15 years , were r and omly assigned to either laxative therapy ( LAX ) , LAX plus enhanced toilet training ( ETT ) , or LAX + ETT + anal sphincter biofeedback ( BF ) .  Daily symptom diaries were completed 14 days before , upon initiation of and 3 months following treatment initiation . ETT and BF were superior to LAX in reducing encopresis . Outcome was significantly predicted by improvement during the initial 14 days of treatment . Reduction of soiling was associated with an increase in bowel movement frequency , and reductions in defecation pain and parental prompting to use the toilet . Because of its efficacy and minimal reliance on technology , ETT should be the initial treatment of choice PURPOSE : Neosphincter procedures may prove to be the treatment of choice for patients with neuropathic fecal incontinence but are rarely proposed for milder forms of the disease . Biofeedback may prove beneficial to these patients but is yet unproven . The objectives of this study were to develop a method of performing biofeedback using transanal ultrasound to teach the patient to contract repetitively and to determine biologic measures of sphincter function using transanal ultrasound in healthy and incontinent patients . METHODS : Initial uncontrolled studies were performed to determine the compliance , normal values , biologic measures of external sphincter strength ( isotonic and isometric fatigue times ) , and early efficacy data using continence scores and visual analog scale scores . RESULTS : Forty-four patients were assessed during three months , with relative improvements in continence scores ( St. Mark 's Hospital , 40 percent ; Pescatori , 20 percent ) and patient and investigator visual analog scale scores ( 38 percent for both ) and measurable increase in biologic fatigue times measured by transanal ultrasound . CONCLUSIONS : Transanal ultrasound seems to be a method of teaching external sphincter contraction and measuring sphincter strength with good initial compliance . Clinical ly and statistically significant improvements in incontinence scores , visual analog scale scores , and biologic strength of the external sphincter were detected in the short-term follow-up with uncontrolled data . The r and omized , controlled trial that we have begun will either confirm or refute these results Abstract PURPOSE : The aim of this study was to assess the long-term clinical and quality of life outcomes for patients after referral to a four-month treatment program for fecal incontinence based on pelvic floor exercises and biofeedback .  Secondary objectives were to document patients ’ subsequent treatment activities and their perception of the biofeedback training ; to establish the long-term outcomes and initial predictors for the subset of patients who did not complete the treatment , or who failed to improve during the program ; and to correlate changes in clinical outcome measures and quality of life over time . METHODS : Patients were contacted by telephone to determine their perception of progress subsequent to the treatment program , any subsequent treatment or activities relating to their fecal incontinence , and which aspect of the treatment program they believed was most helpful . St. Mark ’s and Pescatori fecal incontinence scores were also recorded , along with patients ’ self- assessment s of their incontinence severity and quality of life . RESULTS : Eighty-three ( 69 percent ) patients were contacted for interviews at a median of 42 ( range , 26–56 ) months after program completion . At the time of follow-up , patients who completed the program continued to enjoy strongly significant improvements in all outcome measures , with 75 percent perceiving a symptomatic improvement and 83 percent reporting improved quality of life . For many patients , improvement continued subsequent to program completion . Patients whose incontinence scores became worse during treatment still reported improvement in their quality of life and perceived incontinence severity during the same time period ; many experienced some degree of “ catch-up ” in their continence scores during the follow-up period . Fourteen patients ( 17 percent ) went on to have surgery for fecal incontinence ; of these , 6 ( 7 percent ) had a stoma . Twenty ( 24 percent ) regularly took antidiarrheal medication . Thirty program completers ( 41 percent ) were continuing pelvic floor exercises . CONCLUSIONS : This study confirms the long-term improvement in fecal incontinence achieved through treatment with biofeedback and pelvic floor exercises . In this study , patients also continued to improve after treatment completion , possibly because of the strong emphasis placed on patients during treatment to continue the pelvic floor exercises on their own . The poor correlation between quality of life and quantitative scores of fecal incontinence suggests that there are important aspects of continence that are not being appropriately recognized OBJECTIVES To 
    Output:
    
There are suggestions that rectal volume discrimination training improves continence more than sham training and that anal biofeedback combined with exercises and electrical stimulation provides more short-term benefits than vaginal biofeedback and exercises for women with obstetric-related faecal incontinence .
REVIEW ER 'S CONCLUSIONS The limited number of identified trials together with their method ological weaknesses do not allow a reliable assessment of the possible role of sphincter exercises and biofeedback therapy in the management of people with faecal incontinence .
There is a suggestions that some elements of biofeedback therapy and sphincter exercises may have a therapeutic effect , but this is not certain .