Dyssynergic Defecation in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Rezaie, Ali; Gu, Phillip; Kaplan, Gilaad G.; Pimentel, Mark; Al-Darmaki, Ahmed

doi:10.1093/ibd/izx095

Cited by 29 publications

(34 citation statements)

References 29 publications

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“…Furthermore, CD patients with small intestine involvement usually present diarrhoea without urgency. In our study, urgency and faecal incontinence were frequent manifestations in colonic CD patients and in UC patients since urgency and possible faecal incontinence are symptoms related to cases of colonic and rectal involvement due to the loss of rectal distensibility (39) . We noticed that colonic Crohn's disease may present symptoms similar to those of UC.…”

Section: Discussionmentioning

confidence: 58%

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The Onset of Clinical Manifestations in Inflammatory Bowel Disease Patients

Nóbrega

Silva

Brito

et al. 2018

Arq. Gastroenterol.

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BACKGROUND: The diagnosis of inflammatory bowel disease is often delayed because of the lack of an ability to recognize its major clinical manifestations. OBJECTIVE: Our study aimed to describe the onset of clinical manifestations in inflammatory bowel disease patients. METHODS: A cross-sectional study. Investigators obtained data from interviews and the medical records of inflammatory bowel disease patients from a reference centre located in Brazil. RESULTS: A total of 306 patients were included. The mean time between onset of symptoms and diagnosis was 28 months for Crohn’s disease and 19 months for ulcerative colitis. The main clinical manifestations in Crohn’s disease patients were weight loss, abdominal pain, diarrhoea and asthenia. The most relevant symptoms in ulcerative colitis patients were blood in the stool, faecal urgency, diarrhoea, mucus in the stool, weight loss, abdominal pain and asthenia. It was observed that weight loss, abdominal pain and distension, asthenia, appetite loss, anaemia, insomnia, fever, nausea, perianal disease, extraintestinal manifestation, oral thrush, vomiting and abdominal mass were more frequent in Crohn’s patients than in ulcerative colitis patients. The frequencies of urgency, faecal incontinence, faeces with mucus and blood, tenesmus and constipation were higher in ulcerative colitis patients than in Crohn’s disease patients. The mean time from the onset of clinical symptoms to the diagnosis of Crohn’s disease was 37 months for patients with ileocolonic location, 26 months for patients with ileum location and 18 months for patients with colon location. In ulcerative colitis patients, the mean time from the onset of symptoms to diagnosis was 52 months for proctitis, 12 months for left-sided colitis and 12 months for extensive colitis. CONCLUSION: Ulcerative colitis presented a high frequency of intestinal symptoms, and Crohn’s disease showed a high frequency of systemic manifestations at the onset of manifestation. There was a long delay in diagnosis, but individuals with more extensive disease and more obvious symptoms showed a shorter delay.

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Section: Discussionmentioning

confidence: 58%

“…The UC patients reported more blood and mucus in the stool, urgency, faecal incontinence and tenesmus. More recently, a study suggested that dyssynergic defecation is highly prevalent in IBD patients (39) .…”

Section: Discussionmentioning

confidence: 99%

The Onset of Clinical Manifestations in Inflammatory Bowel Disease Patients

Nóbrega

Silva

Brito

et al. 2018

Arq. Gastroenterol.

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“…A recent systematic review and meta‐analysis on the prevalence, diagnosis, and management of dyssynergic defecation in patients with IBD and symptoms of defecatory dysfunction concluded that symptoms of evacuation difficulty in patients with quiescent IBD do respond to biofeedback training . That systematic review included patients with an ileoanal pouch from a single center, possibly a single patient cohort, published in three separate abstracts, all of which were included in the meta‐analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Many patients continue to experience troublesome bowel symptoms, including fecal urgency, increased bowel frequency, fecal incontinence, constipation (low bowel frequency or impaired rectal evacuation), abdominal pain, or bloating, despite apparent drug‐ or surgically induced disease remission . Fecal incontinence is a key concern for people with IBD .…”

Section: Introductionmentioning

confidence: 99%

Systematic review: Pelvic floor muscle training for functional bowel symptoms in inflammatory bowel disease

et al. 2019

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Background and AimLarge bowel functional symptoms are common in patients with inflammatory bowel disease (IBD) who are in disease remission. The efficacy of pelvic floor muscle training for symptoms of evacuation difficulty or fecal incontinence is well established in patients without organic bowel disease but is unknown in these patients. This study aimed to systematically evaluate the published evidence in this group of patients.MethodsA systematic review was conducted of articles evaluating pelvic floor muscle training, with or without biofeedback, to improve bowel function in patients with quiescent IBD, including those with an ileoanal pouch. The outcome of interest was improved bowel function measured by bowel diary, patient report, or validated questionnaire in randomized controlled studies, cohort studies, or case series.ResultsTwo randomized controlled trials, four retrospective case series, and one prospective study met eligibility criteria. Pelvic floor muscle training for patients with quiescent IBD improved symptoms in 51 of 76 (68%) patients with evacuation difficulty and 20 of 25 (80%) patients with fecal incontinence. Pelvic floor muscle training for patients with an ileoanal pouch, prior to stoma closure, did not appear to reduce the risk or severity of fecal incontinence following stoma closure. Studies were limited by small numbers, study design, methodological quality, and lack of long‐term follow‐up.ConclusionPelvic floor muscle training appears to be of therapeutic value in some patients with quiescent IBD and evacuation difficulty or fecal incontinence. The effectiveness of this approach warrants further investigation.

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“…Importantly, and consistently, these functional bowel symptoms in IBD are associated with significant psychological distress, and impair quality of life to a similar extent to that seen in patients with IBD with confirmed active gastrointestinal inflammation[ 29 , 32 - 37 ]. Similarly, although even less well studied, functional anorectal disorders[ 38 ] including evacuatory disorders[ 39 ] and faecal incontinence[ 40 , 41 ], are often reported in patients with quiescent disease[ 32 ]. In the absence of active inflammation, escalation of IBD therapy, including potentially inappropriate use of corticosteroids or immunosuppressive drugs is likely to be futile[ 42 ], leading to further patient dissatisfaction, costly, and carries the risk of serious adverse effects[ 43 - 47 ].…”

Section: Introductionmentioning

confidence: 99%

Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?

Vasant

Ford

2020

WJG

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Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease (IBD). There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing, rather than clinical remission alone. Consequently, the treatment of refractory “functional” gastrointestinal symptoms, often attributed as the aftermath of previous inflammation, has recently become more prominent in quiescent disease. With further expected advances in anti-inflammatory treatments on the horizon, the burden of such symptoms in quiescent disease, which have been relatively neglected, is set to become an even bigger problem. In this article, we highlight the current state of research and understanding in this field, including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms, such as irritable bowel syndrome and functional anorectal and pelvic floor disorders, in patients with quiescent IBD. These disorders are not only highly prevalent in these patients, they are often misdiagnosed, and are difficult to treat, with very few evidence-based therapies. Moreover, they are associated with substantial impairment in quality-of-life, considerable morbidity, and psychological distress. There is therefore an urgent need for a change in emphasis towards earlier recognition, positive diagnosis, and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active IBD. This article also highlights the need for further research to develop much needed evidence-based therapies.

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Dyssynergic Defecation in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Cited by 29 publications

References 29 publications

The Onset of Clinical Manifestations in Inflammatory Bowel Disease Patients

The Onset of Clinical Manifestations in Inflammatory Bowel Disease Patients

Systematic review: Pelvic floor muscle training for functional bowel symptoms in inflammatory bowel disease

Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?

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