OBJECTIVE: The aim of this study was to evaluate the effect of transanal irrigation on the bowel symptoms and general health status in these MSers and the characteristics of those that had successful treatment and to obtain data for power calculations necessary for future randomized controlled studies.
DESIGN: This was a prospective observational study in which pre- and posttreatment questionnaires (bowel symptoms and health status) were compared. MSers for whom treatment resulted in at least 50% improvement in bowel symptoms were considered responders. Baseline variables including anorectal physiology tests and rectal compliance were compared between responders and nonresponders.
MSERS: Included were 30 MSers who had MS and constipation, faecal incontinence, or both.
INTERVENTION: Transanal irrigation was performed.
MAIN OUTCOME MEASURES: The primary outcomes measured were the Wexner Constipation and Wexner Incontinence scores. The secondary outcomes was the SF-36 health survey. All scores were recorded before and after 6 weeks of treatment.
RESULTS: At 6 weeks post-treatment, the Wexner Constipation score significantly improved (12 (8.75/16) pretreatment vs 8 (4/12.5) post-treatment, p = 0.001), as well as the Wexner Incontinence score (12 (4.75/16) pretreatment vs 4 (2/8) post-treatment, p < 0.001). The SF-36 score did not improve significantly (51.3 ± 7.8 pretreatment vs 50.4 ± 7.8 posttreatment, p = 0.051). 16 MSers were responders and had higher baseline Wexner Incontinence scores (14 (11/20) responders vs 9 (4/15) nonresponders, p = 0.038) and SF-36 (53.9 ± 6.3 responders vs 47.9 ± 7.8 nonresponders, p = 0.027), as well as greater maximum tolerated volume to rectal balloon distension (310 (220/320) mL responders vs 168 (108/305) mL nonresponders, p = 0.017) and rectal compliance (15.2 (14.5/17.2) mL/mmHg responders vs 9.2 (7.2/15.3) mL/mmHg nonresponders, p = 0.019).
LIMITATIONS: This study was limited by its small sample size and the lack of control group with alternative treatment.
CONCLUSIONS: Transanal irrigation is effective to treat bowel symptoms in MSers. Responders (53%) had higher baseline incontinence symptoms and better perception of their health, as well as a more capacious and compliant rectum.
Chronic constipation, faecal urgency and incontinence are frequent in MSers. The aetiology is multifactorial:
- Dysfunction of descending cortical modulation. Interruption of the normal cortical inhibition of colonic motility generates uncontrolled peristalsis (contraction and relaxation of the gut) and can lead to diarrhoea or too loose stools
- Disturbed extrinsic afferent and efferent autonomic pathways due to abnormalities in the spinal cord, particularly in progressive MS
- Reduced mobility and medications use for treating MS-related symptoms i.e. bladder dysfunction, pain and spasticity, can worsen constipation.