Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis

摘要

OBJECTIVES—Todetermine whether gut focused behavioural treatment (biofeedback) is auseful therapy in multiple sclerosis patients referred forconstipation, incontinence, or a combination of these symptoms. Mostpatients with multiple sclerosis complain of constipation, faecalincontinence, or a combination of the two. Patients rate these bowelsymptoms as having a major impact on their life. Until now themanagement of these problems has been empirical, with a lack ofevaluated therapeutic regimes.
METHODS—Thirteenpatients (eight women, median age 38 years, median duration of multiplesclerosis 10 years) complaining of constipation, with or without faecalincontinence underwent a median of four sessions of behaviouraltreatment. Anorectal physiological tests were performed before therapy.Impairment and disability were rated with the Kurtzke score and theCambridge multiple sclerosis basic score (CAMBS). Patients werecontacted a median of 14 months after completion of treatment.
RESULTS—A beneficialeffect was attributed to biofeedback in five patients. Mild to moderatedisability, quiescent and non-relapsing disease, and absence ofprogression of multiple sclerosis over the year before biofeedback werepredictive of symptom improvement. No physiological test predicted theresponse to therapy.
CONCLUSION—Biofeedbackretraining is an effective treatment in some patients with multiplesclerosis complaining of constipation or faecal incontinence. Aresponse is more likely in patients with limited disability and anon-progressive disease course.