Biofeedback Therapy Improves Continence in Quiescent Inflammatory Bowel Disease Patients with Ano-Rectal Dysfunction

Vasant, Dipesh H.; Limdi, Jimmy K.; Solanki, Kumud; Radhakrishnan, N.

doi:10.15226/2374-815x/3/2/00153

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…For those with significant FI, and in whom active inflammation has been excluded, anorectal and pelvic floor motility studies are recommended to help select those that may benefit from pelvic floor physiotherapy and/or biofeedback therapy 38,39 . There is now increasing evidence for improvement in FI in patients with IBD treated with targeted pelvic floor physiotherapy and biofeedback 40–44 . Unfortunately, beyond biofeedback, whilst there is interest in electrical neuromodulation techniques, 45 there is a limited evidence base for interventions such as sacral nerve and tibial nerve stimulation in quiescent UC populations 33 .…”

Section: Discussionmentioning

confidence: 99%

“…38,39 There is now increasing evidence for improvement in FI in patients with IBD treated with targeted pelvic floor physiotherapy and biofeedback. [40][41][42][43][44] Unfortunately, beyond biofeedback, whilst there is interest in electrical neuromodulation techniques, 45 there is a limited evidence base for interventions such as sacral nerve and tibial nerve stimulation in quiescent UC populations. 33 Given the relatively high prevalence of FI, our data therefore highlight the need for further research into the pathophysiology and treatments for FI in UC populations.…”

Section: Iciq Fi N = 201mentioning

confidence: 99%

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The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

Vasant

Nigam

Bate

et al. 2023

Aliment Pharmacol Ther

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Summary Background Despite advances in ulcerative colitis (UC) therapies, a relatively undefined proportion of patients experience faecal incontinence (FI) in the absence of active inflammation. For this group, there remains a significant unmet need with a limited evidence base. Aims We aimed to estimate the prevalence and impact of FI in UC. Methods In a prospective cross‐sectional study, patients with UC completed a series of validated questionnaires, including Rome IV FI criteria, an inflammatory bowel disease (IBD)‐specific FI questionnaire (ICIQ‐IBD), Hospital Anxiety and Depression Scale and IBD‐Control. UC remission was defined as faecal calprotectin (FCP) ≤250 μg/g, or IBD‐control 8 score ≥13 and IBD‐Control‐VAS ≥ 85. Results Of 255 patients with UC, overall, 20.4% fulfilled Rome IV criteria for FI. Rome IV FI prevalence did not differ between active and quiescent UC regardless of whether disease activity was defined by IBD‐Control scores ± FCP (p = 0.25), or objectively with FCP thresholds of 250 μg/g (p = 0.86) and 100 μg/g (p = 0.95). Most patients (75.2%) reported FI when in ‘remission’ and during ‘relapse’ (90.6%) according to ICIQ‐IBD. Those who reported FI according to both ICIQ‐IBD and Rome IV definitions had higher anxiety, depression and worse quality‐of‐life (QoL) scores (p < 0.05). In those with Rome IV FI, there was a strong correlation between FI symptom severity and impaired QoL (r = 0.809, p < 0.001). Conclusions The prevalence of FI in UC is high, even in remission, and associated with significant psychological distress, symptom burden and impaired QoL. These findings highlight the urgent need for further research and development of evidence‐based treatments for FI in UC.

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Section: Discussionmentioning

confidence: 99%

Section: Iciq Fi N = 201mentioning

confidence: 99%

The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

Vasant

Nigam

Bate

et al. 2023

Aliment Pharmacol Ther

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“…Patients with active UC also experience sensory changes and have increased smooth muscle tone, which may result in hypersensitivity and increased rectal contractile responses due to sensitization of intramural receptors in response to inflammatory changes (21)(22)(23)35). However, BU does not always equate to active UC.…”

Section: Mechanisms Driving Bumentioning

confidence: 99%

“…Biofeedback can serve as a safe, effective, and inexpensive means of treating symptoms of UC, including BU, by strengthening anorectal function ( 93 , 101 ). Biofeedback, which encompasses exercises of the pelvic floor and anal sphincter, helps patients manage rectal hypersensitivity, and hypersensitivity can contribute to feelings of BU ( 25 , 35 , 101 ). In patients with quiescent IBD, biofeedback therapy has been demonstrated to improve fecal incontinence as well as overall QoL ( 35 ).…”

Section: Treatments For Bumentioning

confidence: 99%

“…Biofeedback, which encompasses exercises of the pelvic floor and anal sphincter, helps patients manage rectal hypersensitivity, and hypersensitivity can contribute to feelings of BU ( 25 , 35 , 101 ). In patients with quiescent IBD, biofeedback therapy has been demonstrated to improve fecal incontinence as well as overall QoL ( 35 ). In a study of patients with IBD (Crohn disease, N = 23; UC, N = 6) with dyssynergic defecation (including BU) assessed with anorectal manometric testing and treated with biofeedback therapy, 30% of those who completed biofeedback therapy had a clinically significant improvement in Short Inflammatory Bowel Disease Questionnaire scores with a significant reduction in healthcare utilization through 6 months ( P = 0.02) ( 77 ).…”

Section: Treatments For Bumentioning

confidence: 99%

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Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions

et al. 2023

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Bowel urgency, the sudden or immediate need for a bowel movement, is one of the most common and disruptive symptoms experienced by patients with ulcerative colitis. Distinct from the separate symptom of increased stool frequency, bowel urgency has a substantial negative impact on quality of life and psychosocial functioning. Among patients with ulcerative colitis, bowel urgency is one of the top reasons for treatment dissatisfaction and one of the symptoms patients most want improved. Patients may not discuss bowel urgency often due to embarrassment, and healthcare providers may not address the symptom adequately due to lack of awareness of validated tools and/or knowledge of the importance of assessing bowel urgency. The mechanism of bowel urgency in ulcerative colitis is multifactorial and includes inflammatory changes in the rectum that may be linked to hypersensitivity and reduced compliance of the rectum. Responsive and reliable patient-reported outcome measures of bowel urgency are needed to provide evidence of treatment benefits in clinical trials and facilitate communication in clinical practice. This review discusses the pathophysiology and clinical importance of bowel urgency in ulcerative colitis and its impact on quality of life and psychosocial functioning. Patient-reported outcome measures developed to assess the severity of bowel urgency in ulcerative colitis are discussed alongside overviews of treatment options and clinical guidelines. Implications for the future management of ulcerative colitis from the perspective of bowel urgency are also explored.

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Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?

Vasant

Ford

2020

WJG

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Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease (IBD). There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing, rather than clinical remission alone. Consequently, the treatment of refractory “functional” gastrointestinal symptoms, often attributed as the aftermath of previous inflammation, has recently become more prominent in quiescent disease. With further expected advances in anti-inflammatory treatments on the horizon, the burden of such symptoms in quiescent disease, which have been relatively neglected, is set to become an even bigger problem. In this article, we highlight the current state of research and understanding in this field, including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms, such as irritable bowel syndrome and functional anorectal and pelvic floor disorders, in patients with quiescent IBD. These disorders are not only highly prevalent in these patients, they are often misdiagnosed, and are difficult to treat, with very few evidence-based therapies. Moreover, they are associated with substantial impairment in quality-of-life, considerable morbidity, and psychological distress. There is therefore an urgent need for a change in emphasis towards earlier recognition, positive diagnosis, and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active IBD. This article also highlights the need for further research to develop much needed evidence-based therapies.

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Biofeedback Therapy Improves Continence in Quiescent Inflammatory Bowel Disease Patients with Ano-Rectal Dysfunction

Cited by 3 publications

References 12 publications

The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions

Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?

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