A gut-directed, pelvic floor behavioral treatment regimen helped improve symptoms of fecal incontinence and constipation in patients with inflammatory bowel disease who did not respond to medical therapy, according to research published in Inflammatory Bowel Diseases.
Angela J. Khera, BAppSc (Physio), of the department of gastroenterology at St. Vincent’s Hospital in Melbourne, Australia, and colleagues wrote that many patients with IBD continue to have bowel problems even when their disease is in remission. This can lead to anxiety, increased health care utilization and loss of productivity.
“Patients may have the perception that having a chronic disease means having chronic symptoms even when their disease is under control,” Khera said in a video abstract. “Symptoms tend to be underreported by patients and underrecognized by health care professionals. Effective treatments to reduce or relieve these symptoms are required but have received little attention.”
Since previous studies have shown bowel and pelvic floor muscle retraining to be effective in patients without IBD, Khera and colleagues explored the strategy in patients with IBD.
Researchers analyzed data from consecutive patients with IBD and symptoms of fecal incontinence or constipation. Forty patients with IBD (median age, 35 years; 80% female; 24 with Crohn’s disease; 12 with ulcerative colitis; 4 with ileoanal pouch) underwent gut directed behavioral treatment, including pelvic muscle training, as well as lifestyle modifications and biofeedback therapy. The primary outcome was patient-reported rating of change in symptoms based on a seven-point Likert scale following completion of treatment.
Investigators found that 77% of patients with fecal incontinence reported improvement of “6 = much better” or “7 = very much better” (17/22), while 83% of patients with constipation reported similar improvement (15/18).
Khera said their findings show a similar response in patients with IBD as previously reported results in non-IBD patients, and the improvement occurred regardless of IBD diagnosis, previous perianal fistula, colorectal surgery, presence of ileoanal pouch or past obstetric trauma.
“We therefore encourage health care professionals to regularly inquire with their patients about ongoing symptoms even when in remission and consider referral for behavioral therapy for those with bothersome symptoms,” Khera said. “Simple management strategies can often make a big difference.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.