title: Transanal irrigation for bowel symptoms in patients with multiple sclerosis.
abstract: BACKGROUND
  Constipation and fecal incontinence affect 68% of patients with multiple sclerosis, but management is empirical. Transanal irrigation has been used successfully in patients with neurogenic bowel dysfunction.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effect of transanal irrigation on the bowel symptoms and general health status in these patients and the characteristics of those that had successful treatment and to obtain data for power calculations necessary for future randomized controlled studies.
  
  
  METHODS
  This was a prospective observational study in which pre- and posttreatment questionnaires (bowel symptoms and health status) were compared. Patients 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.
  
  
  METHODS
  This study was conducted at a specialist neurogastroenterology clinic, tertiary referral center.
  
  
  METHODS
  Included were 30 patients who had multiple sclerosis and constipation, fecal incontinence, or both.
  
  
  METHODS
  Transanal irrigation was performed.
  
  
  METHODS
  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 posttreatment, the Wexner Constipation score significantly improved (12 (8.75/16) pretreatment vs 8 (4/12.5) posttreatment, p = 0.001), as well as the Wexner Incontinence score (12 (4.75/16) pretreatment vs 4 (2/8) posttreatment, 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). Sixteen patients 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).
  
  
  CONCLUSIONS
  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 patients with multiple sclerosis. Responders (53%) had higher baseline incontinence symptoms and better perception of their health, as well as a more capacious and compliant rectum.
authors.affiliation: GI Physiology Unit, University College London Hospital, London, United Kingdom.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Preziosi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gosling
authors.forename: Amanda
authors.initials: A
authors.lastname: Raeburn
authors.forename: Julie
authors.initials: J
authors.lastname: Storrie
authors.forename: Jalesh
authors.initials: J
authors.lastname: Panicker
authors.forename: Anton
authors.initials: A
authors.lastname: Emmanuel
mesh_terms: D000328:Adult; D003248:Constipation / Q000503:physiopathology / Q000628:therapy*; D004185:Disability Evaluation; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome