Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis

Objectives-To determine whether gut focused behavioural treatment (biofeedb ack) is a useful therapy in multiple sclerosis patients referred for consti pation, incontinence, or a combination of these symptoms. Most patients wit h multiple sclerosis complain of constipation, faecal incontinence, or a co mbination of the two. Patients rate these bowel symptoms as having a major impact on their life. Until now the management of these problems has been e mpirical, with a lack of evaluated therapeutic regimes. Methods-Thirteen patients (eight women, median age 38 years, median duratio n of multiple sclerosis 10 years) complaining of constipation, with or with out faecal incontinence underwent a median of four sessions of behavioural treatment. Anorectal physiological tests were performed before therapy. Imp airment and disability were rated with the Kurtzke score and the Cambridge multiple sclerosis basic score (CAMBS). Patients were contacted a median of 14 months after completion of treatment. Results-A beneficial effect was attributed to biofeedback in five patients. Mild to moderate disability, quiescent and non-relapsing disease, and abse nce of progression of multiple sclerosis over the year before biofeedback w ere predictive of symptom improvement. No physiological test predicted the response to therapy. Conclusion-Biofeedback retraining is an effective treatment in some patient s with multiple sclerosis complaining of constipation or faecal incontinenc e. A response is more likely in patients with limited disability and a non- progressive disease course.