Biofeedback Therapy Improves Continence in Quiescent Inflammatory Bowel Disease Patients with Ano-Rectal Dysfunction

Introduction: Despite optimal disease control and absence of objective markers of mucosal inflammation, fecal incontinence (FI) secondary to anorectal dysfunction is common, difficult to treat and significantly reduces quality of life (QoL) in quiescent Inflammatory Bowel Disease (IBD). Whilst biofeedback therapy (BFT) is an established treatment for FI, its role in IBD patients with anorectal dysfunction has not been explored.

Methods: Retrospectively we reviewed all IBD cases referred for ano-rectal manometry (ARM) and BFT at our institution between 2009-2014. For each patient, data confirming IBD quiescence (endoscopic, histology, radiography and biochemistry), IBD phenotypes, medication, surgical and obstetric histories, baseline FI frequency, QoL scores (rated 0-10) and results of anorectal investigations were recorded. Patients were classified as responders or non-responders to BFT based on symptoms at follow-up.

Results: Nine quiescent IBD patients (6/9 crohn's and 3/9 ulcerative colitis, median age 53, 7/9 females), with baseline median FI frequency 11.5/week and QoL score 6, had BFT following ARM. Manometrically, all had external anal sphincter weakness, 6/9 internal anal sphincter weakness, 2/9 with co-existing dyssynergic defecation and 8/9 had rectal hypersensitivity. Following a median 2 BFT sessions; 8/9 (89%) patients improved with reduced FI frequency (U=0.5, P=0.003) and 5/9 (56%) became fully continent.

Conclusions: BFT appears to be just as effective for FI in IBD patients as it is in non-IBD populations and may have a role in restoring continence and QoL. This data highlights the importance of anorectal physiology studies in symptomatic patients once active inflammation is excluded.