[Prospective, double-blind study of topical phenylephrine treatment for nocturnal fecal incontinence in patients after ileoanal pouch construction]

Abstract

Patients: Fecal incontinence has been reported in 5.5% to 45% of patients after ileoanal pouch construction, predominantly at night. It has been shown that alpha1-adrenergic agonists as phenylephrine increase anal sphincter pressure in healthy volunteers and in patients with idiopathic fecal incontinence. The median duration of action of topical phenylephrine is seven hours. Carapeti et al have demonstrated its usefulness in patients after ileoanal pouch construction.

Objective: To demonstrate that the administration of a single dose of topical 10% phenylephrine at night is effective for the treatment of nocturnal anal incontinence in this group of patients.

Patients and methods: We randomized 12 patients in two groups. Group A (control) received a placebo cream and group B received a 10% phenylephrine cream. The study was prospective, randomized and double-blind.

Results: There were no significant differences between the two groups in age, follow-up time since the closure of ileostomy and pre-treatment and intra-treatment leaks. Control group had 7 episodes of incontinence pre-treatment and 9 intra-treatment. Treated group had 3 and 5.4, respectively. (p = NS) No patient had side effects.

Conclusions: Given the small number of patients included, we can not yet rule out that topical 10% phenylephrine is useful for the treatment of nocturnal fecal incontinence in patients after ileoanal pouch construction. It would be necessary to continue with studies, increasing the number of patients treated with this drug, in order to have a better evidence of its clinical utility.