{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:28:54Z","timestamp":1791286134138,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD088688"],"award-info":[{"award-number":["R01HD088688"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine if a biofeedback therapy that includes concentric resistance exercise for the anal sphincter muscles can improve muscle strength\/function and improve AI symptoms compared to the traditional\/non\u2010resistance biofeedback therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Biofeedback therapy is the current gold standard treatment for patients with anal incontinence (AI). Lack of resistance exercise biofeedback programs is a limitation in current practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010three women with AI (mean age 60\u00a0years) were randomly assigned to concentric (resistance) or isometric (non\u2010resistance) biofeedback training. Concentric training utilized the Functional Luminal Imaging Probe to provide progressive resistance exercises based on the patient's ability to collapse the anal canal lumen. Isometric training utilized a non\u2010collapsible 10\u00a0mm diameter probe. Both groups performed a biofeedback protocol once per week in the clinic for 12\u00a0weeks and at home daily. High definition anal manometry was used to assess anal sphincter strength; symptoms were measured using FISI and UDI\u20106. 3D transperineal ultrasound imaging was used to assess the anal sphincter muscle integrity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Concentric and isometric groups improved FISI and UDI\u20106 scores to a similar degree. Both the concentric and isometric groups showed small improvement in the anal high\u2010pressure zone; however, there was no difference between the two groups. Ultrasound image analysis revealed significant damage to the anal sphincter muscles in both patient groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Concentric resistance biofeedback training did not improve the anal sphincter muscle function or AI symptoms beyond traditional biofeedback training. Anal sphincter muscle damage may be an important factor that limits the success of biofeedback training.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14212","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T10:58:31Z","timestamp":1625741911000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence?"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1704-2747","authenticated-orcid":false,"given":"Lori J.","family":"Tuttle","sequence":"first","affiliation":[{"name":"Doctor of Physical Therapy Program School of Exercise &amp; Nutritional Sciences San Diego State University San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Zifan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Medicine University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Swartz","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy Program School of Exercise &amp; Nutritional Sciences San Diego State University San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5228-9617","authenticated-orcid":false,"given":"Ravinder K.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Medicine University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.396"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.10.062"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v11.i31.4771"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(83)80236-4"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2004.02125.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gastro.2003.09.039"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2008.06.008"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181915670"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2003.10.057"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.025"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.12818"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-020-0749-7"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12258"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.04.026"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.02.028"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e3182a18e87"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000078"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30193-1"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2012.06.001"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2018.27"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.190"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(99)70194-0"}],"container-title":["Neurogastroenterology &amp; 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