Trans-anal irrigation in patients with multiple sclerosis: Efficacy in treating disease-related bowel dysfunctions and impact on the gut microbiota: A monocentric prospective study

Abstract

Background Constipation and faecal incontinence are not so uncommon in patients with multiple sclerosis, impairing quality of life. The gut microbiota is altered in multiple sclerosis patients and likely contributes to disease pathogenesis. Trans-anal irrigation has been proven to allow treatment of neurogenic bowel dysfunction and may affect gut microbiota. Objectives The primary outcome was trans-anal irrigation effectiveness on constipation and faecal incontinence. The secondary outcome was gut microbiota profiling compared to healthy subjects and during trans-anal irrigation adoption. Methods We conducted a prospective cohort study on multiple sclerosis patients, screened with Patient Assessment of Constipation Quality of Life questionnaire before undergoing constipation and faecal incontinence scoring, abdomen X-ray for intestinal transit time, compilation of food and evacuation diaries and faecal sample collection for gut microbiota analysis before and after 4 weeks of trans-anal irrigation. Results and Conclusions Eighty patients were screened of which nearly half had intestinal symptoms. The included population (n = 37) was predominantly composed of women with significantly longer disease duration, higher mean age and disability than the excluded one ( p < 0.05). Twelve patients completed the trans-anal irrigation phase, which led to significant improvement of bowel dysfunction symptom-related quality of life, increase in gut microbiota diversity and reduction of the proportions of pro-inflammatory taxa ( p < 0.05). Trans-anal irrigation was safe, satisfactory and could help counteract multiple sclerosis-related dysbiosis.

Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury and Multiple Sclerosis—An Updated and Simplified Treatment Algorithm

“…Research regarding NBD within patients with MS is likewise scant. Recommendations are usually based on results from patients within the SCI group or idiopathic bowel symptoms, leaving clinicians with the above-mentioned limitations and the lack of a formalized approach regarding bowel symptoms [1,2,16,19,26,28,53].…”

“…Within the MS population, several studies concluded that TAI improved bowel symptoms and quality of life in persons with NBD [5,53,54]. Amongst MS patients, one study found that the sole predictive factor for successful treatment was impaired anal electrosensitivity at baseline [5].…”

The Functional Implications of Transanal Irrigation: Insights from Pathophysiology and Clinical Studies of Neurogenic Bowel Dysfunction

“…In another study, Ascanelli et al studied the effects of TAI on FI and constipation in MS individuals [ 69 ]. Quality of life and NBD scores both improved after using TAI for these patients.…”

“…When pressurized water is introduced via the inflated rectal balloon catheter, it stretches the luminal wall and activates gut pacemaker cells. The activation of intrinsic neuromuscular mechanisms interferes with the hyper-reflexic bowel, which is characterized by overactive segmental peristalsis In another study, Ascanelli et al studied the effects of TAI on FI and constipation in MS individuals [69]. Quality of life and NBD scores both improved after using TAI for these patients.…”