Biofeedback for the Treatment of Anal Incontinence in a Child with Ureterosigmoidostomy

The case of a 7-year-old boy born with exstrophy of the bladder is presented. Biofeedback and behavioral therapy were employed in the treatment of anal incontinence, which occurred following ureterosigmoidostomy diversion. After 19 treatment and follow-up sessions over a period of 12 months, there was significant decrease in fecal/urinary incontinence. The patient was soiled 29% of waking hours over the first 4 weeks of treatment. This figure dropped to 9.7% over the last three sessions. Subjective satisfaction of parent, child, and teachers was high. These gains were maintained over a 12-month follow-up period. Given the design of the present study, it is not possible to determine whether the biofeedback per se had a specific treatment effect. The case demonstrates the usefulness of a broad-based behavior therapy in the management of fecal/urine soiling, which is a frequent, refractory complication of ureterosigmoidostomy.