J Neurogastroenterol Motil.  2022 Apr;28(2):320-326. 10.5056/jnm19040.

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

• Teng M
• Miget G
• Moutounaïck M
• Kervinio F
• Charlanes A
• Chesnel C
• Breton FL
• Amarenco G

• KMID: 2528047
• DOI: http://doi.org/10.5056/jnm19040

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.

Keyword

Lower urinary tract symptoms; Multiple sclerosis; Neurogenic bowel; Therapeutic irrigation