Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults

Christine Norton; June D Cody

doi:10.1002/14651858.CD002111.pub3

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Figure 1

PRISMA study flow diagram.

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Analysis 1.1

Comparison 1 Anal sphincter exercises/PFMT with or without biofeedback versus no treatment, Outcome 1 Number of people failing to achieve full continence (worse, unchanged or improved).

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Analysis 1.2

Comparison 1 Anal sphincter exercises/PFMT with or without biofeedback versus no treatment, Outcome 2 Number of people with no improvement in incontinence status (worse or unchanged).

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Analysis 1.3

Comparison 1 Anal sphincter exercises/PFMT with or without biofeedback versus no treatment, Outcome 3 Number of incontinence episodes per week.

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Analysis 1.8

Comparison 1 Anal sphincter exercises/PFMT with or without biofeedback versus no treatment, Outcome 8 Sensory threshold (rectal balloon distension ‐ ml).

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Analysis 2.7

Comparison 2 Anal sphincter exercises/PFMT with or without biofeedback versus any other treatment alone, Outcome 7 Number of people dissatisfied with the treatment.

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Analysis 3.1

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 1 Number of people failing to achieve full continence (worse, unchanged or improved).

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Analysis 3.4

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 4 Number of incontinence episodes per week.

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Analysis 3.5

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 5 Number of pad changes required per week.

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Analysis 3.6

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 6 Incontinence score.

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Analysis 3.15

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 15 General health measures.

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Analysis 3.16

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 16 Condition specific quality of life measures.

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Analysis 3.17

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 17 Psychological health measures.

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Analysis 3.19

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 19 Satisfaction with treatment (VAS).

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Study	Resting pressure	Squeeze pressure	Fatigue time
Exercises + BF + education vs exercises + education
Ilnyckyj 2005	Education plus = 51.6 (mm [H2O]) Control (education) = 34.1 (mm [H2O])	Education plus BF = 91.7 (mm [H2O]) Control = 81.3 (mm [H2O])	Treatment = 19.4 Control = 14.0

Analysis 3.20

Comparison 3 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone, Outcome 20 Manometric pressures (medians).

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Analysis 4.1

Comparison 4 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus exercises with or without biofeedback, Outcome 1 Number of people failing to achieve full continence (worse, unchanged or improved).

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Analysis 4.2

Comparison 4 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus exercises with or without biofeedback, Outcome 2 Number of people with no improvement in incontinence status (worse or unchanged).

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Analysis 4.6

Comparison 4 Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus exercises with or without biofeedback, Outcome 6 Incontinence score.

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Analysis 5.1

Comparison 5 Anal sphincter exercises/PFMT and biofeedback versus anal sphincter exercises/PFMT alone, Outcome 1 Number of people failing to achieve full continence (worse, unchanged or improved).

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Analysis 5.3

Comparison 5 Anal sphincter exercises/PFMT and biofeedback versus anal sphincter exercises/PFMT alone, Outcome 3 Number of people dissatisfied with the treatment.

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Study	St Marks Vaizey 0‐13	Pescatori (0‐6)	Self‐rating (0‐10)
Solomon 2003	Ultrasound BFB = 7 Manometric = 6 Exercises only = 8	Ultrasound BFB = 4 Manometric BFB = 4 Exericses alone = 4	Ultrasound BFB = 3.6 Manometric BFB = 4.0 Exericses alone = 3.5

Analysis 6.7

Comparison 6 One type of biofeedback versus another type of biofeedback, Outcome 7 Incontinence score (median).

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Study	Resting pressure	Squeeze pressure	Fatigue time
Solomon 2003	Ultrasound BFB = 44 (mm Hg) Manometric BFB = 45 (mm Hg) Exericses alone = 48	Ultrasound BFB = 95 (mm Hg) Manometric BFB = 78 (mm Hg) Exericses alone = 90	Ultrasound BFB = 27 (sec) Manometric BFB = 21 (sec) Exericses alone = 15

Analysis 6.13

Comparison 6 One type of biofeedback versus another type of biofeedback, Outcome 13 Manometric pressures (medians).

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Comparison 1. Anal sphincter exercises/PFMT with or without biofeedback versus no treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number of people failing to achieve full continence (worse, unchanged or improved) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Number of people with no improvement in incontinence status (worse or unchanged) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 Number of incontinence episodes per week Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

4 Number of pad changes required per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Incontinence score	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Number of people with adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Number of people dissatisfied with the treatment	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Sensory threshold (rectal balloon distension ‐ ml) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

9 Manometric resting pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Manometric squeeze pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Manometric squeeze increment (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Duration of squeeze (seconds)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 General health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Condition specific quality of life measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Psychological health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Activities of daily living measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Anal sphincter exercises/PFMT with or without biofeedback versus no treatment

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Comparison 2. Anal sphincter exercises/PFMT with or without biofeedback versus any other treatment alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number of people failing to achieve full continence (worse, unchanged or improved)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number of people with no improvement in incontinence status (worse or unchanged)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number of incontinence episodes per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number of pad changes required per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Incontinence score	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Number of people with adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Number of people dissatisfied with the treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

7.1 Biofeedback vs electrical stimulation	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Sensory threshold (rectal balloon distension ‐ ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Manometric resting pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Manometric squeeze pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Manometric squeeze increment (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Duration of squeeze (seconds)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 General health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Condition specific quality of life measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Psychological health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Activities of daily living measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Anal sphincter exercises/PFMT with or without biofeedback versus any other treatment alone

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Comparison 3. Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number of people failing to achieve full continence (worse, unchanged or improved) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Exercises +BF+ ES vs ES alone	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number of people with no improvement in incontinence status (worse or unchanged)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Satisfaction with the treatment	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number of incontinence episodes per week Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

4.1 Exercises + drugs vs SNS	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number of pad changes required per week Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

5.1 Exercises + drugs vs SNS	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Incontinence score Show forest plot	3		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

6.1 Exercises + BF + surgery vs surgery alone	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 Exercises + drugs vs SNS	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.3 Exercises + BF + ES vs ES alone	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Number of people with adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Sensory threshold (rectal balloon distension ‐ ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Manometric resting pressure	0		Mean Difference (IV, Fixed, 95% CI)	Totals not selected
9.1 Exercises + BF + ES vs ES alone	0		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Manometric squeeze pressure (cm of water)	0		Mean Difference (IV, Fixed, 95% CI)	Totals not selected
10.1 Exercises + BF + ES vs ES alone	0		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Manometric squeeze increment (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Duration of squeeze (seconds)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Vector symmetry index	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Saline retention test (ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 General health measures Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

15.1 Exercises + drugs vs SNS	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Condition specific quality of life measures Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

16.1 Exercises + drugs vs SNS	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Psychological health measures Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

17.1 Exercises + drugs vs SNS	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Activities of daily living measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Satisfaction with treatment (VAS) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

19.1 Exercises + BF + surgery vs surgery alone	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Manometric pressures (medians) Show forest plot			Other data	No numeric data

20.1 Exercises + BF + education vs exercises + education			Other data	No numeric data

Comparison 3. Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus any other treatment alone

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Comparison 4. Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus exercises with or without biofeedback

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number of people failing to achieve full continence (worse, unchanged or improved) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Exercises + BF + ES vs exercises + BF alone	2	167	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.46, 0.78]
2 Number of people with no improvement in incontinence status (worse or unchanged) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 Exercises + BF + ES vs exercises + BF alone	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number of people dissatisfied with the treatment	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number of incontinence episodes per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number of pad changes required per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Incontinence score Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

6.1 Exercises + BF + ES vs exercises + BF alone	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7 Number of people with adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Sensory threshold (rectal balloon distension ‐ ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Manometric resting pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Manometric squeeze pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Manometric squeeze increment (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Duration of squeeze (seconds)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Vector symmetry index	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Saline retention test (ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 General health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Condition specific quality of life measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Psychological health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Anal sphincter exercises/PFMT with or without biofeedback and another treatment versus exercises with or without biofeedback

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Comparison 5. Anal sphincter exercises/PFMT and biofeedback versus anal sphincter exercises/PFMT alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number of people failing to achieve full continence (worse, unchanged or improved) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Number of people with no improvement in incontinence status (worse or unchanged)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number of people dissatisfied with the treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4 Number of incontinence episodes per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number of pad changes required per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Incontinence score	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Number of people with adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Sensory threshold (rectal balloon distension ‐ ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Manometric resting pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Manometric squeeze pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Manometric squeeze increment (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Duration of squeeze (seconds)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Vector symmetry index	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Saline retention test (ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 General health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Condition specific quality of life measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Psychological health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Activities of daily living measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Anal sphincter exercises/PFMT and biofeedback versus anal sphincter exercises/PFMT alone

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Comparison 6. One type of biofeedback versus another type of biofeedback

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number of people failing to achieve full continence (worse, unchanged or improved)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number of people with no improvement in incontinence status (worse or unchanged)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number of people dissatisfied with the treatment	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number of incontinence episodes per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number of pad changes required per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Incontinence score	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Incontinence score (median) Show forest plot			Other data	No numeric data

8 Number of people with adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Sensory threshold (rectal balloon distension ‐ ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Manometric resting pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Manometric squeeze pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Manometric squeeze increment (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Manometric pressures (medians) Show forest plot			Other data	No numeric data

14 Duration of squeeze (seconds)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Vector symmetry index	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Saline retention test (ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 General health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Condition specific quality of life measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Psychological health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Activities of daily living measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Activities of daily living measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 6. One type of biofeedback versus another type of biofeedback

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Comparison 7. One type of anal sphincter exercises/PFMT versus another type of anal sphincter exercises/ PFMT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number of people failing to achieve full continence (worse, unchanged or improved)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number of people with no improvement in incontinence status (worse or unchanged)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number of incontinence episodes per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number of pad changes required per week	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Incontinence score	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Number of people with adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Number of people dissatisfied with the treatment	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Sensory threshold (rectal balloon distension ‐ ml)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Manometric resting pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Manometric squeeze pressure (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Manometric squeeze increment (cm of water)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Duration of squeeze (seconds)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 General health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Condition specific quality of life measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Psychological health measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Activities of daily living measures	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 7. One type of anal sphincter exercises/PFMT versus another type of anal sphincter exercises/ PFMT

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