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【論文摘要】Effect of Neuromuscular Electrical Stimulation Combined With Kegel Exercise on Quality of Life and Sphincter Control for Patient With Fecal Incontinence After Lower Anterior Resection of Rectum, Colostomy and Radiotherapy: A Case Report

【論文摘要】接受過低位直腸切除術並有肛失禁的患者以神經肌肉電刺激結合凱格爾運動的介入模式對生活品質及括約肌控制的效果:個案報告

摘要


Background and Purpose: The losing bowl movement is a frequent disorder after lower anterior resection (LAR) of rectum. There are few effective and standard approaches for patient with fecal incontinence. Our patient was a 57-year-old man diagnosed rectal cancer T2 pN1aM0, stage IIIA. After accepting LAR and colostomy, he had done about 5-month postoperative radiotherapy (RT) and one year follow up. We assumed that neuromuscular electrical stimulation (NMES), biofeedback (BF) and Kegel exercise will also be effective for defecation control, strengthening weak sphincter muscles and increase his quality of life (QoL). Methods: Patient accepted NMES with 2 tunnel modes (35 Hz, 500 μs, 25 mA and 50 Hz, 400 μs, 30 mA) 20 min, 1-2 times/week, sphincter endurance and control exercise with BF 20 min and Kegel exercise, 20 min, 1-2 times/week. Outcome measures are sphincter control, endurance and QoL. We recorded sphincter holding timing rate (SHTR), successful control rate and failure rate. Florida Fecal Incontinence Scale (FFIS) was used to represent patient QoL. Results: The SHTR improved from 43.7% to 64% and the successful control rate increased from 42% to 87%. Finally, the FFIS decreased from 7 to 0. Conclusion: Patient performed better sphincter control and endurance also improved his QoL without fecal incontinence after 3 sessions, 18 time treatments. Although we had good outcome, there were still some independent factors for clinical stuff and farther research to consider like patient's motivation, frequency, intensity of electrical stimulation (ES), and timing to start physical therapy after follow up. Clinical Relevance: Our results provided an effective intervention for patient with fecal incontinence after LAR of rectum, colostomy, and RT.

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