Introduction Despite optimal disease control and the absence of objective evidence of mucosal inflammation, symptoms of faecal incontinence (FI), increased stool frequency, urgency and tenesmus secondary to anorectal dysfunction can significantly reduce quality of life (QoL) in Inflammatory Bowel Disease (IBD) patients. Biofeedback therapy (BFT) is an established treatment for FI but its role in IBD patients with Anorectal dysfunction has not been explored.
Methods In a retrospective study, we reviewed all patients with IBD referred for Anorectal Manometry (ARM) studies and BFT at our institution between 2009–2014 for FI.1 Data confirming IBD quiescence was recorded with endoscopy, histology, radiography and biochemistry from all subjects. Additionally, IBD phenotypes and therapies, surgical and obstetric histories, baseline FI frequency, QoL scores (rated 0–10), ARM data and Endoanal Ultrasonography results (when available) were recorded. Patients were classified as responders or non-responders to BFT based on symptoms at follow-up.
Results Nine IBD patients (median age 53, 7/9 female), with quiescent IBD (6/9 Crohn’s Disease (CD) and 3/9 Ulcerative Colitis (UC)), median baseline FI frequency 11.5/week and QoL score 6, completed in our Gastroenterologist-led BFT programme. In the CD cohort; 1/6 had previous anal fistula repair, 2/6 previous right hemicolectomy with ileal resection and 3/6 crohns colitis. In the UC group; 2/3 patients had proctitis/proctosigmoiditis and the other patient had ileo-anal pouch post-panproctocolectomy. Based on ARM findings; All patients had external sphincter weakness 9/9, whilst 6/9 had internal anal sphincter weakness and 2/9 met criteria for co-existing dyssynergic defecation. Following a mean of 3 BFT sessions; 8/9 (89%) patients reported improvement in FI symptoms with statistically significant improvement in FI frequency compared to baseline (Mann-Whitney U = 0.5, P = 0.003) and 5/9 (56%) reporting no FI episodes.
Conclusion Our data in a heterogenous cohort of IBD patients with moderate QoL scores and FI despite disease quiescence, highlights the importance of considering referral for ARM studies after excluding active inflammation. BFT appears to be as effective in IBD patients as it is in non-IBD patients with FI and may have a role in improving QoL in these patients.
Reference 1 Vasant D, Solanki K, Sharma R, et al. Ptu-180 predicting outcomes of biofeedback therapy for faecal incontinence – where ‘good’ practice makes perfect. Gut 2015;64:A142.
Disclosure of Interest None Declared