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Neurogastroenterol Motil. 2016 Sep;28(9):1349-55. doi: 10.1111/nmo.12833. Epub 2016 Apr 26.

Long-term efficacy and safety of transanal irrigation in multiple sclerosis.

Author information

1
GI Physiology Unit, University College London Hospital and National Hospital for Neurology & Neurosurgery, London, UK.
2
Department of Physiology, University of Bristol, Bristol, UK.

Abstract

BACKGROUND:

Multiple sclerosis (MS) is the commonest disabling neurological disease in young adults. A majority of patients experience bowel dysfunction, reporting a wide spectrum of bowel symptoms that significantly negatively impact social activities and emotional state. Transanal irrigation (TAI) is a method of managing such bowel symptoms. We aimed to investigate long-term efficacy of TAI, to measure health status-related quality of life and identify factors predictive of TAI outcome.

METHODS:

Forty-nine consecutive MS patients (37 female; mean age 51, range 26-80) were studied. We investigated predominant symptoms, reason for beginning TAI and medical comorbidity. All patients underwent anorectal physiology testing. They completed Neurogenic Bowel Dysfunction and EQ-5D questionnaires at baseline and annual follow-up.

KEY RESULTS:

Mean follow-up was 40 months, at which there was 55% rate of continuation of TAI. Severe bowel dysfunction was present in 47% at baseline, falling to 18%. The EQ-5D scores at latest follow-up were not statistically significant, but 42% had improved visual analog scores. The only predictive factor for successful therapy was impaired anal electrosensitivity (p = 0.008).

CONCLUSIONS & INFERENCES:

Long-term continuation of TAI, with improved bowel symptomatology, is seen in the majority of patients. The EQ-5D is insufficiently sensitive to show change in MS patients that using TAI.

KEYWORDS:

constipation; fecal incontinence; health-related quality of life; multiple sclerosis; neurological bowel dysfunction; transanal irrigation

PMID:
27117939
DOI:
10.1111/nmo.12833
[Indexed for MEDLINE]

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