Diagnostiek bij fécale incontinentie : beperkte voorspellende waarde voor de uitkomst van bekkenbodemfysiotherapie

OBJECTIVE: To develop an efficient diagnostic strategy for patients with faecal incontinence to identify subgroups that may benefit from pelvic floor physiotherapy. DESIGN: Cohort study. METHOD: Assessment of consecutive patients with faecal incontinence treated at 15 hospitals in a 24-month period. In addition to medical history and physical examination, a complete diagnostic work-up was performed. All patients were then offered standardised pelvic floor physiotherapy. Treatment outcome was evaluated by change in Vaizey incontinence score 3 months after therapy. Linear regression analysis was used to calculate the predictive value of each diagnostic test and combination of tests with regard to treatment outcomes. RESULTS: Of the 281 patients included (mean age 59 years), 252 were female. The median Vaizey score was 18 at baseline and 16 after therapy (p < 0.001). The Vaizey score improved in 143/239 patients (60%). The presence of perineal or perianal scarring on physical examination or internal anal sphincter atrophy on endoanal MRI were associated with a negative treatment outcome. A high maximal squeeze pressure by anorectal manometry was associated with a positive treatment outcome. The predictive value of information obtained by medical history and additional tests was limited (R2: 0.23; p = 0.02). CONCLUSION: Pelvic floor physiotherapy provided a modest improvement in symptoms of faecal incontinence. The predictive value of additional tests in predicting outcomes following pelvic floor physiotherapy was limited. Subgroups of patients could not be identified based on diagnostic test information