Physiotherapy interventions for improving fecal incontinence and quality of life of people after colorectal surgery: A systematic review and meta-analysis

Purpose: To investigate the effectiveness of physiotherapy interventions on fecal incontinence (FI) and the quality of life (QoL) of people after colorectal cancer surgery.
Methods: Multiple databases were searched from database inception until November 2022. Studies comparing the effectiveness of physiotherapy interventions against control conditions were included. The risk of bias in the included studies was assessed using the Revised Cochrane Risk-of-bias Tool.
Results: Ten trials were included in the review. Meta-analysis revealed statistically significant improvements in lifestyle [Mean difference (MD) 0.54 (95% CI 0.03, 1.05); p = 0.04], coping behavior [MD 1.136 (95% CI 0.24, 2.04); p = 0.01] and embarrassment [MD 0.417 (95% CI 0.14, 0.70); p = 0.00] components of QoL from pelvic floor muscle training (PFMT) when compared to a control group receiving usual care (UC). Meta-analysis showed that biofeedback is significantly more effective than UC in enhancing anal resting pressure (ARP; MD 9.551 (95% CI: 2.60, 16.51); p = 0.007], mean squeeze pressure (MSP; MD 25.29 (95% CI 4.08, 48.50); p = 0.02] and rectal resting pressure (RRP; MD 0.51 (95% CI: 0.10, 0.9); p = 0.02]. The meta-analysis also showed that a combination of PFMT and biofeedback is significantly more effective than PFMT alone in improving ARP [MD 3.00 (95% CI 0.40, 5.60); p = 0.02], MSP [MD 9.35 (95% CI 0.17, 18.53); p = 0.05] and RRP [MD 1.54 (95% CI 0.60, 2.47); p = 0.00].
Conclusion: A combination of PFMT plus biofeedback can be considered for improving FI in people after colorectal surgery. Biofeedback was found to have superior benefits over UC in QoL of people with FI following colorectal surgery. Future research is needed to determine the optimal parameters for PFMT and biofeedback to improve QoL and FI in people after colorectal surgery.