Validation of a Multimodal Algorithm for the Treatment of Fecal Incontinence

NCT ID: NCT05026970

Last Updated: 2021-08-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-01

Study Completion Date

2023-05-01

Brief Summary

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Thisi is a pragmatical clinical trial with the main aim of main aim of evaluating the effectiveness of the combination of treatments for the management of fecal incontinence (FI), on profiles of patients with IF based on pathophysiological criteria, measuring physiological, clinical and quality of life outputs.

Secondary:

1. Evaluate the presence of SIBO, gluten-sensitive enteropathy, malabsorption of bile salts or sugars in patients with Bristol stools ≥5 that condition the fecal continuity.
2. Effect of change in fecal consistency on IF symptoms.
3. To evaluate the effect of the combination of treatments on anorectal physiology and neurophysiology (motor and sensory), clinical severity and quality of life.
4. Evaluate the persistence of the treatments to the three months of end of the same.

Detailed Description

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FI is a very prevalent condition in community dwelling women. We have previously studied the efectivenes of four treatments in women with FI as well as the effect on the anorectal physiology and neurophysiology. All treatments improved clinical symptoms of FI but there were no statistical differences between the treatments, that were Kegel exercises (K), biofeedback (BF)+K, electrostimulation (ES)+K, and transcutaneous neuromodulation (tNM)+K. With this prevoous study we have a clearer idea of the anorectal physiology which should allow to select patients for given treatments.

For the present study we try to validate a multimodal algorithm to treat FI, taking into account the underlying pahtophysiology.

It will have 2 differentiated stages:

Stage 1: Patients with loose stools (Bristol \>5): they will be studied to determine the cause of the diahrrea (mainly food intolerances) and treated accordingly. If FI symptoms remain, patients will pass to:

Stage 2: Patients with Bristol\<6 anf FI symptoms. They will be adressed to 3 combinations of treatments according to the pathophysiology that explain the symptoms, which will be:

BF+ES+K: those patients with direct sphincter damage BF+tNM+K: patients with external anal sphincter dennervation and/or colonic motility disorders.

BF alones: patients with FI mainly explained by a bad control of the pelvic floor function (akinesia/dyssynergia).

All patients will be studied with High Resolution Anorectal Manometry, PNTML, endoanal unltrasonography. Clinical severity and QoL with dedicated intruments or questionnaires.

If after 1sr stage, if so, patients have a clinical severity of Cleveland\<4 they will be followed up at 3 months with K, studued again their clinical severity and QoL.

After 2nd stage, if so, 3-month of targeted treatment will be performed, and reevaluated with HRAM, PNTML and clinical questionnaires. They will be followed up at 3 monts with only K to study the persistance of the treatments.

Conditions

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Fecal Incontinence

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Biofeedback+Electrostimulation+Kegel

Biofeedback (3 sessions) Electrostimulation (12 weeks daily treatment) Kegel exercises (twice daily)

Group Type ACTIVE_COMPARATOR

Biofeedback+Tibial Neuromodulation+Kegel

Intervention Type DEVICE

Biofeedback (3 sessions) Transcutaneous Neuromodulation (12 weeks daily treatment) Kegel exercises (twice daily)

Biofeedback+Kegel

Intervention Type COMBINATION_PRODUCT

Biofeedback+Kegel exercises

Biofeedback+Tibial Neuromodulation+Kegel

Biofeedback (3 sessions) Transcutaneous Neuromodulation (12 weeks daily treatment) Kegel exercises (twice daily)

Group Type ACTIVE_COMPARATOR

Biofeedback+Electrostimulation+Kegel

Intervention Type COMBINATION_PRODUCT

Biofeedback (3 sessions) Electrostimulation (12 weeks daily treatment) Kegel exercises (twice daily)

Biofeedback+Kegel

Intervention Type COMBINATION_PRODUCT

Biofeedback+Kegel exercises

Biofeedback+Kegel

Biofeedback (6 sessions) Kegel exercises (twice daily)

Group Type ACTIVE_COMPARATOR

Biofeedback+Electrostimulation+Kegel

Intervention Type COMBINATION_PRODUCT

Biofeedback (3 sessions) Electrostimulation (12 weeks daily treatment) Kegel exercises (twice daily)

Biofeedback+Tibial Neuromodulation+Kegel

Intervention Type DEVICE

Biofeedback (3 sessions) Transcutaneous Neuromodulation (12 weeks daily treatment) Kegel exercises (twice daily)

Interventions

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Biofeedback+Electrostimulation+Kegel

Biofeedback (3 sessions) Electrostimulation (12 weeks daily treatment) Kegel exercises (twice daily)

Intervention Type COMBINATION_PRODUCT

Biofeedback+Tibial Neuromodulation+Kegel

Biofeedback (3 sessions) Transcutaneous Neuromodulation (12 weeks daily treatment) Kegel exercises (twice daily)

Intervention Type DEVICE

Biofeedback+Kegel

Biofeedback+Kegel exercises

Intervention Type COMBINATION_PRODUCT

Other Intervention Names

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BF+ES+K BF+tNM+K BF+K

Eligibility Criteria

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Inclusion Criteria

* FI episodes at least 6 months before
* FI episodes each month
* No other treatment the year before
* Able to self-administer treatments

Exclusion Criteria

* Pregnancy
* If, to investigators criteria, patient will fail to administer the tratmetns properly, due to physical or psychic conditions
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Hospital de Mataró

OTHER

Sponsor Role lead

Responsible Party

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Lluís Mundet

Motility Unit Coordinator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Hospital de Mataró

Mataró, Barcelona, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Alba Raventós, Nurse

Role: CONTACT

937417700 ext. 2748

Lluís Mundet

Role: CONTACT

Facility Contacts

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Lluís Mundet

Role: primary

937417700 ext. 2756

Other Identifiers

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16/19

Identifier Type: -

Identifier Source: org_study_id

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