Operant Conditioning of Rectosphincteric Responses in the Treatment of Fecal Incontinence

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Abstract
Six patients with severe fecal incontinence and manometric evidence of external-sphincter impairment were taught to produce external-sphincter contraction in synchrony with internal-sphincter relaxation. These responses were induced by rectal distention. During follow-up periods ranging from six months to five years, four of the patients remained completely continent, and the other two were definitely improved. One patient who was trained to relax her internal sphincter as well as to contract her external sphincter not only was continent but also regularly had normal bowel movements, which she had not had before. The training technic was relatively simple to apply, and learning occurred within four sessions or less. The findings highlight the Importance of synchronized rectosphincteric responses in the maintenance of fecal continence, and they show that these responses can be brought under voluntary control in patients with chronic fecal Incontinence, even when the incontinence is secondary to organic lesions. (N Engl J Med 290:646–649, 1974)