Transanal Irrigation for Neurogenic Bowel Dysfunction in Multiple Sclerosis: A Retrospective Study

Abstract

Background/aims: Sixty-eight percent of multiple sclerosis (MS) patients suffer from neurogenic bowel dysfunction (NBD). Transanal irrigation (TAI) is part of the therapeutic strategy. This retrospective study aims to assess the efficacy of TAI in MS population.

Methods: Twenty-eight MS patients who underwent TAI after a learning period were included. We collected several demographic data: MS disease characteristics, treatments, urinary and bowel dysfunction characteristics, urodynamic parameters, results of the NBD score, the Urinary Symptom Profile (USP) score, and the Patient Global Impression of Severity score, completed by patients before the learning and during the follow-up consultation. We defined 4 specific groups depending on the NBD score severity: very minor, minor, moderate, and severe.

Results: Mean follow-up was 124 days, 85.0% were initially constipated and 36% had fecal incontinence. After TAI, improvement of NBD score was higher in initial Moderate NBD score group with 75.0% of patients decreasing their NBD score into lower severity categories. Few modifications were observed for baseline Very minor and Severe NBD score groups with 60.0% and 87.5% of patients staying in the same category. Statistical improvement of USP voiding dysfunction score was observed (95% CI, -6.13--1.19; P = 0.005) without improvement of overactive bladder USP sub-score.

Conclusions: TAI is effective in NBD, especially in MS patients with initial Moderate NBD score. Improvement of voiding dysfunction following TAI confirms the pelvic organ cross-talk and the need to systematically consider and treat bowel dysfunction in MS to also improve urinary symptoms.

Keywords: Lower urinary tract symptoms; Multiple sclerosis; Neurogenic bowel; Therapeutic irrigation.

Figure 1

Flow chart of the patients’ inclusion. TAI, transanal irrigation; NBD, neurogenic bowel dysfunction score.

Figure 2

Evolution of the neurogenic bowel dysfunction (NBD) score before and after transanal irrigation in 4 specific initial NBD categories. “Very minor group” is defined by NBD score ranged from 0 to 6, “Minor group” is defined by score ranging from 7 to 9, “Moderate group” is defined by score ranging from 10 to 13, “Severe group” is defined by NBD score ranging from 14 to 27. Red boxes correspond to the analyzed groups.