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

Khera, Angela; Chase, Janet; Salzberg, Michael; Thompson, Alexander; Kamm, Michael A.

doi:10.1002/jgh3.12207

Cited by 8 publications

(13 citation statements)

References 70 publications

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“…The median PDS score was 1.25 (range 0-7.5) and was strongly positively correlated with the COREFO score (r = 0.82 [P < 0.0001]). The median score and interquartile range (IQR) for the COREFO domains were incontinence 15 , impact 19 , frequency 38 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38), stool-related aspects 17 , and medication 33 .…”

Section: Resultsmentioning

confidence: 99%

“…Pelvic floor muscle dysfunction is frequently associated with evacuation problems 33 and pouchitis 34 in patients with an ileoanal pouch. Patients with inactive inflammatory bowel disease or an ileoanal pouch who have fecal incontinence or evacuation difficulty respond to behavioral treatment, including pelvic floor muscle training or “biofeedback.” 9,33,35 The increased postoperative rate of poor pouch function in patients with preoperative nocturnal fecal incontinence suggest that this group may benefit from perioperative behavioral training to improve bowel function, although this now needs to be proven prospectively.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of long‐term function and general well‐being in patients with an ileoanal pouch

et al. 2020

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Background and aim: Fecal incontinence and/or evacuation difficulty are common after ileoanal pouch surgery. This study aimed to determine whether the development of these symptoms can be predicted so that preventive measures might be instituted. Methods: A consecutive series of 46 patients with ulcerative colitis (median age at surgery, 41 years; 50% female) and a functioning pouch for a duration ≥12 months was included. Assessment utilized medical record review and questionnaires on preand postoperative bowel function, quality of life, and psychological well-being. Pouch function was assessed by the Colorectal Functional Outcome score (0 = no impairment, 100 = worst impairment). Good pouch function was defined as a score ≤24. Results: Fecal incontinence occurred in 67% preoperatively and 54% postoperatively; evacuation difficulty occurred in 65% and preoperatively and 85% postoperatively. The postoperative median Colorectal Functional Outcome score was 20 (range 2-74), with 44% of patients >24 (poor pouch function). Preoperative nocturnal fecal incontinence (odds ratio [OR] 4.92, 95% confidence interval [CI] 1.2-19.4, P = 0.02) and pouchitis (OR 5.41, 95% CI 1.2-23.7, P = 0.02) were associated with poor pouch function after multivariable regression analysis. Postoperative satisfaction, psychological well-being, and quality of life were significantly better in those with good pouch function, while poor sleep, impaired work, and sexual dysfunction were independently associated with poor pouch function. Conclusions: Functional bowel symptoms are common before and after pouch surgery and are associated with the impairment of patient-reported outcomes. Preoperative nocturnal fecal incontinence predicts poor pouch function. Therapeutic focus on continence, bowel evacuation, psychological well-being, and quality of life should begin before surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Determinants of long‐term function and general well‐being in patients with an ileoanal pouch

et al. 2020

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“…Faecal incontinence is a humiliating loss of self-control at any age and possibly more so for young people who fear stigmatization and isolation from their peer group as a result. It is inextricably linked to self-confidence and daily activities and relationships (Khera, Chase, Salzberg, Thompson, & Kamm, 2019). Yet, despite this there does not seem to be a good solution for this problem (Saldana, Ruiz, & Kaiser 2017) with management of faecal incontinence and investigations into therapeutic interventions receiving little attention (Khera et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Experiences of Adolescents Who Are Living with Inflammatory Bowel Disease

Holmes¹,

Banwell²,

Lucas³

et al. 2021

GJHS

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BACKGROUND: Inflammatory bowel disease (IBD) is an incurable, chronic, gastrointestinal condition characterised by recurrent bouts of debilitating abdominal pain and diarrhoea. There is little information on how adolescents with paediatric IBD (PIBD) face the challenges of living with the disease and their perceptions of their journeys towards adulthood. This paper reports the findings of a qualitative study on these issues in adolescents living with PIBD in South Australia. METHODS: Potential study participants, aged between 12 and 17 years were selected by a treating clinician from the PIBD clinic of a major referral hospital, to achieve gender balance and some diversity in the PIBD stage and severity. In-depth face-to-face interviews focused on participants’ perceptions about living with IBD during adolescence and for the future. Interviews were recorded, transcribed and analyzed thematically. RESULTS: Nine adolescents aged 15-17 years consented to participate in the study. Using an overarching theme of ‘the journey’, three major temporal themes were apparent, namely, ‘Reactions at time of diagnosis’, ‘Learning to cope with IBD’ and ‘Acceptance and the future with IBD’. This study demonstrates that, even with optimum support, the pathways towards adulthood were often turbulent and challenging for these young people due to the unpredictability of painful and/or embarrassing physical symptoms. They nevertheless developed strategies which enabled them to accept and cope with a new ‘normality’ with positivity and determination. More research is warranted to investigate the skills required to navigate this path successfully.

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“…The patients were educated about PF anatomy and function. Using the PERFECT scheme ( Laycock & Jerwood, 2001 ) which evaluates PF power, number of squeezes the patient can perform and the endurance, individually tailored self-treatment protocol was defined for each patient consisting of the following parts: Reeducation of the defecation act in patients with the constipation - increased position of lower extremities, voluntary relaxation of the PF with subsequent training of the targeted localized pressure to the rectum and abdominal massage ( Cotterill et al, 2018 ; Khera et al, 2019 ). Bowel drill/bladder drill –during urgency the individual pulls the PF in and squeezes the sphincters to stop the urgency and avoid the leaks ( Booth et al, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

“…Reeducation of the defecation act in patients with the constipation - increased position of lower extremities, voluntary relaxation of the PF with subsequent training of the targeted localized pressure to the rectum and abdominal massage ( Cotterill et al, 2018 ; Khera et al, 2019 ).…”

Section: Methodsmentioning

confidence: 99%

Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach

Kövári

Šťovíček

Novák

et al. 2022

NRE

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BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark’s Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.

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

Cited by 8 publications

References 70 publications

Determinants of long‐term function and general well‐being in patients with an ileoanal pouch

Determinants of long‐term function and general well‐being in patients with an ileoanal pouch

Experiences of Adolescents Who Are Living with Inflammatory Bowel Disease

Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach

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