Biofeedback at St Mark’s Hospital

This is a nurse-led service, headed by Nurse Consultant Professor Christine Norton PhD MA RN. We have a team of specialist nurses and physiotherapists who manage patients with a range of functional gastrointestinal disorders, including faecal incontinence and constipation as the two largest groups. We have 700-800 new referrals each year and 70-80% of patients report improved symptoms, with lasting effect for the majority (Chiotakakou-Faliakou 1998; Norton & Kamm 1999). The nurses and physiotherapists work within a multidisciplinary team and patients can be discussed with, or referred to a gastroenterologist, colorectal surgeon, counsellor, psychologist, psychotherapist, dietician and other nurse specialists if indicated. Regular clinical supervision and audit of case decisions is undertaken by the Nurse Consultant and a Consultant Gastroenterologist. However, we do expect that referring doctors have considered possible bowel pathology and investigated patients appropriately prior to referral for biofeedback.

Patients are posted a symptom questionnaire and bowel diary to complete and bring to the first appointment. Initially, each patient will have a one hour assessment interview initially. Thereafter, patients are seen approximately monthly, by the same therapist. The majority have 4-6 sessions.

Constipation

Constipated patients will have a pre-arranged abdominal transit X-ray study and a proctogram X-ray if indicated, on the same day and be seen with the result. Any further tests indicated by the assessment can be arranged by the nurse specialist. Each patient will have a one hour assessment interview with a clinical nurse specialist initially. This determines the symptoms and any contributing factors. A detailed explanation of bowel function is given. The patient is taught correct evacuation techniques using a range of exercises developed at this hospital (Storrie 1997). Advice is also given of a range of related issues such as diet, fluid intake, lifestyle and stress management.

Faecal incontinence

Patients with faecal incontinence will have an anal ultrasound and anorectal physiology tests pre-arranged on the same day and be seen with the results. Any further tests indicated by the assessment can be arranged by the nurse specialist. Each patient will have a one hour assessment interview with a clinical nurse specialist (Norton & Chelvanayagam 2000). This determines the symptoms and any contributing factors. A detailed explanation of bowel function is given. The patient is taught to exercise the anal sphincter and pelvic floor, usually using computer-assisted biofeedback equipment (Norton & Chelvanayagam 2001). Some patients are also loaned a home electrical stimulator. Advice is also given of a range of related issues such as diet, fluid intake, lifestyle and stress management (Norton & Kamm 1999a).

For further details contact Lead Nurse (Bowel Control) Brigitte Collins: Brigitte.collins@nwlh.nhs.uk

For further information on advice given to patients see our website: www.bowelcontrol.org.uk