For Refractory Faecal Incontinence, Biofeedback Matches Injection at Lower Cost: CGH | October 2026

What Did the Study Find?

The five-centre FIT trial enrolled adults experiencing at least four faecal-incontinence episodes over two weeks despite medical and behavioural therapy. Two hundred nonresponders—176 women and 24 men—were randomised to anorectal biofeedback or anal dextranomer–hyaluronic-acid injection.

At three months, the prespecified clinically stringent endpoint of at least a 75% reduction in incontinence episodes occurred in 29/99 patients receiving biofeedback and 28/101 receiving injection: 29.3% versus 27.7%. Injection was not superior (adjusted OR 0.9; 95% CI 0.5–1.7). Relevant adverse events occurred in five injection recipients and two biofeedback recipients, without a significant difference. Injection cost payers an average US$1,563 more per patient and society US$1,579 more. Most participants were women, and longer-term comparative effectiveness remains uncertain. ScienceDirect

Why Does It Matter?

The trial supplies the direct comparison previously missing from management pathways. Since efficacy was modest and essentially equivalent, treatment burden, local expertise, availability and cost should drive shared decision-making; where accessible, biofeedback is the more economical initial escalation.

GastroAGI Takeaway

After optimised conservative treatment fails, consider anorectal biofeedback before injectable bulking therapy: approximately three in ten achieved major improvement, with no efficacy advantage—and substantially higher cost—for injection.