Rectal Digital Maneuvers May Predict Outcomes and Help Customize Treatment Intensity of Biofeedback in Chronic Constipation and Dyssynergic Defecation

Neurogastroenterology Motil

Whorwell

2019

Self Cite

Background Despite their high prevalence and advances in the field of neurogastroenterology, there remain few effective treatment options for functional gastrointestinal disorders (FGIDs). It is recognized that approximately 25% of sufferers will have symptoms refractory to existing therapies, causing significant adverse effects on quality of life and increased healthcare utilization and morbidity. Gut‐focused hypnotherapy, when delivered by trained therapists, has been shown to be highly effective in severe refractory FGIDs. However, hypnotherapy continues to be surrounded by much misunderstanding and skepticism. Purpose The purpose of this review is to provide a contemporary overview of the principles of gut‐focused hypnotherapy, its effects on gut‐brain interactions, and the evidence‐base for its efficacy in severe FGIDs. As supplementary material, we have included a hypnotherapy protocol, providing the reader with an insight into the practical aspects of delivery, and as a guide, an example of a script of a gut‐focused hypnotherapy session.

Section: Areas For Future Research and Developmentmentioning

confidence: 99%

Section: Are a S For Future Re S E Arch And De Velopmentmentioning

confidence: 99%

Gut‐focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence‐base, practical aspects, and the Manchester Protocol

Neurogastroenterology Motil

Whorwell

2019

Self Cite

Section: Identifying Patients With Functional Anorectal Disorders In mentioning

confidence: 99%

“…The need to use rectal digital manoeuvres to help evacuate stool is an important clinical feature in suspected defaectory disorders and has been shown to be a predictive of outcomes to pelvic floor biofeedback therapy for evacuatory disorders. 37,38 Clinicians must proactively screen for FI, as studies have shown that FI affects up to 74% of IBD patients, 39,40 but is often underreported due to fear of embarrassment. 41 FI is one of the most embarrassing symptoms suffered by patients with IBD and can be socially debilitating and isolating, impacting heavily on the quality of life of the patients.…”

Section: Historymentioning

confidence: 99%

Current perspectives on the diagnosis and management of functional anorectal disorders in patients with inflammatory bowel disease

Nigam

Limdi

Therap Adv Gastroenterol

2018

Self Cite

Despite advances in inflammatory bowel disease (IBD) therapies, a significant proportion of patients with quiescent disease experience persistent, debilitating symptoms of faecal incontinence (FI), urgency and defaecatory disorders due to anorectal dysfunction. Such symptoms are often underreported or misdiagnosed and can lead to potentially premature treatment ‘escalation’ and under-utilisation of pelvic floor investigations. In this review article, we consider putative pathophysiological post-inflammatory changes resulting in altered anorectal sensitivity, motility and neuromuscular coordination and how this may drive symptoms in quiescent IBD. Finally, we discuss a pragmatic approach to investigating and managing anorectal dysfunction and highlight areas for future research for this often-neglected group of patients.

“…These include IBS symptoms (abdominal pain, bloating, and altered bowel habit or stool form), obstructive defaecatory symptoms, including incomplete emptying, straining, features of overflow diarrhoea or impaction, and rectal digitation. The latter is an important clinical feature, which appears to be predictive of response to pelvic floor biofeedback[ 50 , 51 ]. Faecal incontinence should also be specifically screened, for as it has been shown to be highly prevalent in patients with IBD[ 52 ], but may be underreported due to embarrassment on the part of patients[ 53 ].…”

Section: Introductionmentioning

confidence: 99%

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

Ford

2020

WJG

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.