Bệnh nhân được hướng dẫn để tự quản lý kích thích điện với một đầu dò cắm qua đường hậu môn. Thiết bị này cung cấp một làn sóng vuông của dòng điện xoay chiều giữa một khoảng thời gian làm việc của một vài giây và phần còn lại một khoảng thời gian gấp đôi | Chapter 15 Rehabilitation and Biofeedback 169 Electrostimulation Electrical stimulation can induce muscle contraction by direct stimulation or indirectly via peripheral nerve stimulation. Anal electrical stimulation can be used to treat fecal incontinence and the rehabilitative cycle is performed daily for some months by the patient in the home environment 19 . Patients are instructed to self-administer electrical stimulation with an anal plug probe. The device delivers a square wave of current alternating between a work period of a few seconds and a double rest period according to a standard sequence. The daily routine is modulated on a program based on 1 current pulse width in milliseconds and frequency in hertz and 2 duration minutes day and frequency number day of sessions. The therapeutic effects are unpredictable because they depend on current type and intensity application time and tissue impedance. Moreover some scientific papers underline that electrostimulation is not a clinically effective treatment of anal incontinence and that passive electrostimulation therapy of the anal sphincter is inferior to active biofeedback training 23 24 . A Cochrane review 25 and a recent randomized trial 26 did not alleviate these doubts. Some patients feel better after electrical stimulation and incontinence may improve but there is no objective effect on anal sphincter pressures. Positive effects on the anal sphincter may be due to intrinsic muscular factors that are commonly found when the electrostimulation is used in other somatic districts. Anal electrostimulation however could decrease the sphincteric tendency toward fatigue 23 and the compound muscle action potential of the external anal sphincter could be significantly increased by electrical stimulation 27 . After all as the main possible mechanism of benefit the improvement of incontinence could be conducive to better anal sensory awareness 26 28 . Multimodal Rehabilitation Multimodal rehabilitation is the latest
