Alternative Approaches to the Treatment of Fecal Incontinence

Biofeedback and anal electrostimulation are considered to be established techniques for the treatment of chronic fecal incontinence when the involuntary loss of stool cannot be stopped by surgery, by general measures such as optimizing stool consistency, or by the treatment of an underlying proctological condition. In fact the terms “biofeedback” and “electrical stimulation” cover a wide range of therapies, which have been subjected to varying methods of evaluation. The available literature on the subject does not allow a systematic comparison of different forms of treatment (1). No general recommendation to treat fecal incontinence in any particular way can be derived from the individual studies published to date (2). Despite this, certain types of treatment without any clear evidence of efficacy are now reimbursable by the statutory health insurance carriers in Germany, while others cannot be ordered. The frequent result is a fruitless struggle with the Medical Service of Health Insurance Companies in Germany (Medizinischer Dienst der Krankenversicherung, MDK) and with the statutory health insurance carriers (Gesetzliche Krankenversicherungen, GKV), ending in the refusal of payment for indicated treatment. Such conflicts are annoying, and the denial of treatment for our patients is regrettable. Yet there is a real lack of evidence-based treatment due to the inadequacy of scientific study in this area.