Arvid Stordahl

Sphincter training or anal injections of dextranomer for treatment of anal incontinence: a randomized trial

Abstract Objective. The objective is to test if the injection of a bulking agent in the anal canal is superior to sphincter training with biofeedback in the treatment of anal incontinence. Background. Anal incontinence is traditionally treated with conservative measures, such as pads and constipating medicine. If this fails, sphincter training with biofeedback is often offered before more advanced surgical procedures are considered. The injection of a bulking agent in the anal canal is a relatively new and promising treatment option. Methods. In a randomized, controlled, evaluator-blinded trial, 126 adult patients with anal incontinence were randomly assigned to a transanal, submucosal injection of 4 x 1 mL of dextranomer in hyaluronic acid or to sphincter training with biofeedback. The primary outcome was severity of incontinence, evaluated by St Marks score for incontinence (0 = continence to 24 = complete incontinence) assessed at 2 years after the start of treatment. A mixed models analysis was applied. Results. Of the 126 participants, 64 patients were randomly assigned to anal injections, and among them the mean St Marks score improved from 12.9 (95% CI: 11.8–14.0) at baseline to 8.3 (95% CI: 6.7–9.8) at the end of follow up. Among the 62 patients who were assigned to sphincter training with biofeedback, there was a corresponding improvement in St Marks score from 12.6 (95% CI: 11.4–13.8) to 7.2 (95% CI: 7.2–8.8). Comparisons of St Marks scores between the groups showed no differences in effect between treatments. Conclusion. The efficacy of anal injections and biofeedback in treating anal incontinence did not differ in this randomized, single-blinded, controlled trial.

Translation and validation of the Norwegian version of the fecal incontinence quality-of-life scale.

Background and Aim: Fecal incontinence quality-of-life scale (FIQLS) is a condition-specific health-related quality-of-life questionnaire composed of four scales: lifestyle, coping/behaviour, depression/self-perception and embarrassment. It has been widely translated and used as an evaluation tool for patients with fecal incontinence. Our aim was to translate the FIQLS, and to test some of the psychometric properties of the Norwegian version of the questionnaire. Material and Methods: The FIQLS was translated to Norwegian, and administered to a sample of 76 patients (73 women) who completed the questionnaire at baseline and again after three weeks. In addition, the severity of incontinence was assessed by phone-interviews (St. Marks score). Results: Three of four domains had good internal consistency in terms of Cronbachs alpha (.83–.91), the fourth (embarrassment) somewhat lower (.64). Stability over time was acceptable for all domains with ICC ranging from .74 to .86. Correlation with severity of incontinence (St. Marks score) was medium to large for all four domains (–.46 to –.63) supporting the construct validity of the Norwegian FIQLS. Conclusion: The Norwegian version of fecal incontinence quality-of-life scale has been successfully translated and tested.

Prevalence and predictors of anal incontinence 6 years after first delivery

The main aim of the present study, was to explore prevalence and predictors of anal incontinence (AI) experienced 6 years after first delivery.

Authors' reply re: Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

Sir, We thank Drs Ryu and colleagues for their interesting comments in response to our trial on gestational weight gain (GWG) in overweight and obese women. We agree that GWG and obesity in pregnancy are important, partly overlapping factors in adverse pregnancy outcomes, and that a significant amount of research has focused on methods to reduce GWG. We note that in meta-analysis, dietary interventions appear to be most successful at reducing GWG, compared with exercise or other interventions, but studies have shown mixed results in reducing the incidence of other important adverse maternal and neonatal outcomes. Our study and others’ results have led us to revise our initial hypothesis: we now feel that serial self-weighing alone is unlikely to alter GWG or health outcomes for overweight and obese women and their children in any predictable way. Nevertheless, it is extremely reassuring to know that women do not suffer anxiety or diminished quality of life when they participate in research aimed at controlling GWG. We anticipate that serial self-weighing will remain in research and clinical practice. For example, we await results from a low-cost, woman centred, mobile-health (mhealth) intervention for overweight and obese pregnant women in which serial self-weighing is one component.&