Faecal Incontinence: Clonidine and Anorectal Sensorimotor Function
Faecal Incontinence: Clonidine and Anorectal Sensorimotor Function
Background Women with faecal incontinence and rectal urgency have increased rectal stiffness and sensation.
Aim To evaluate the effects of clonidine, an α2-adrenergic agonist, in faecal incontinence.
Methods In this open-label uncontrolled study, bowel symptoms and anorectal functions (anal pressures, rectal compliance, and sensation) were assessed before and during treatment with transdermal clonidine (0.2 mg daily, 4 weeks) in 12 women with urge-predominant faecal incontinence.
Results Clonidine reduced the frequency (17.8 ± 3.1 before vs. 8.8 ± 3.9 after, P = 0.03) and number of days with faecal incontinence (11.8 ± 1.6 before vs. 6.1 ± 1.8 after, P = 0.02), faecal incontinence symptom severity score (max = 13, 8.3 ± 0.7 vs. 5.6 ± 0.9, P < 0.01), and allowed patients to defer defecation for a longer duration (P = 0.03). Although overall effects on anorectal functions were not significant, the treatment-associated reduction in faecal incontinence episodes was associated with increased rectal compliance (r = −0.58, P < 0.05) and reduced rectal sensation. (r = −0.73, P = 0.007 vs. desire to defecate pressure threshold).
Conclusions Clonidine improves symptoms in women with faecal incontinence; this improvement is associated with increased rectal compliance and reduced rectal sensitivity. A controlled study is necessary to confirm these observations.
Faecal incontinence (FI) is a relatively common problem, particularly among women and the elderly, which can significantly impair daily functioning and also contribute to institutionalization. Current management relies upon conservative measures to modify diet and bowel habits and biofeedback therapy for patients who do not respond to other conservative measures. Although amitryptiline and loperamide improved diarrhoea and rectal urgency in uncontrolled studies, the use of these agents is often limited by constipation. The role of anal sphincteroplasty remains unclear because continence is preserved in ≤40% of patients 3–5 years after surgery. Sacral nerve stimulation can also improve FI.
Although most attention has focused on anal sphincter injury and weakness, there is increasing evidence for rectal sensorimotor dysfunctions in FI. For example, we observed reduced rectal capacity in 27% and reduced rectal compliance in 23% of women with FI. Reduced rectal capacity was more common in women with (i.e. 36%) than without (i.e. 8%) urgency. These observations have been confirmed by other groups.
Clonidine is an α2-adrenergic agonist that inhibits gastrointestinal motor activity by presynaptically inhibiting acetylcholine release from nerves in the myenteric plexus and at the neuromuscular junction. Adrenergic α2 receptors are also widely distributed on nociceptive pathways in the spinal cord, brain stem and forebrain. In humans, clonidine (i) reduced colonic tone, but not the colonic response to a meal, increased colonic compliance and reduced colonic perception in healthy subjects; (ii) reduced rectal compliance and rectal sensation in healthy subjects; and (iii) improved symptoms in diarrhoea-predominant IBS. Therefore, this study evaluated the effects of clonidine on symptoms and anorectal sensorimotor funCtions in FI. Our hypotheses were that clonidine will improve symptoms and anorectal sensorimotor dysfunctions in women with urge-predominant FI.
Abstract and Introduction
Abstract
Background Women with faecal incontinence and rectal urgency have increased rectal stiffness and sensation.
Aim To evaluate the effects of clonidine, an α2-adrenergic agonist, in faecal incontinence.
Methods In this open-label uncontrolled study, bowel symptoms and anorectal functions (anal pressures, rectal compliance, and sensation) were assessed before and during treatment with transdermal clonidine (0.2 mg daily, 4 weeks) in 12 women with urge-predominant faecal incontinence.
Results Clonidine reduced the frequency (17.8 ± 3.1 before vs. 8.8 ± 3.9 after, P = 0.03) and number of days with faecal incontinence (11.8 ± 1.6 before vs. 6.1 ± 1.8 after, P = 0.02), faecal incontinence symptom severity score (max = 13, 8.3 ± 0.7 vs. 5.6 ± 0.9, P < 0.01), and allowed patients to defer defecation for a longer duration (P = 0.03). Although overall effects on anorectal functions were not significant, the treatment-associated reduction in faecal incontinence episodes was associated with increased rectal compliance (r = −0.58, P < 0.05) and reduced rectal sensation. (r = −0.73, P = 0.007 vs. desire to defecate pressure threshold).
Conclusions Clonidine improves symptoms in women with faecal incontinence; this improvement is associated with increased rectal compliance and reduced rectal sensitivity. A controlled study is necessary to confirm these observations.
Introduction
Faecal incontinence (FI) is a relatively common problem, particularly among women and the elderly, which can significantly impair daily functioning and also contribute to institutionalization. Current management relies upon conservative measures to modify diet and bowel habits and biofeedback therapy for patients who do not respond to other conservative measures. Although amitryptiline and loperamide improved diarrhoea and rectal urgency in uncontrolled studies, the use of these agents is often limited by constipation. The role of anal sphincteroplasty remains unclear because continence is preserved in ≤40% of patients 3–5 years after surgery. Sacral nerve stimulation can also improve FI.
Although most attention has focused on anal sphincter injury and weakness, there is increasing evidence for rectal sensorimotor dysfunctions in FI. For example, we observed reduced rectal capacity in 27% and reduced rectal compliance in 23% of women with FI. Reduced rectal capacity was more common in women with (i.e. 36%) than without (i.e. 8%) urgency. These observations have been confirmed by other groups.
Clonidine is an α2-adrenergic agonist that inhibits gastrointestinal motor activity by presynaptically inhibiting acetylcholine release from nerves in the myenteric plexus and at the neuromuscular junction. Adrenergic α2 receptors are also widely distributed on nociceptive pathways in the spinal cord, brain stem and forebrain. In humans, clonidine (i) reduced colonic tone, but not the colonic response to a meal, increased colonic compliance and reduced colonic perception in healthy subjects; (ii) reduced rectal compliance and rectal sensation in healthy subjects; and (iii) improved symptoms in diarrhoea-predominant IBS. Therefore, this study evaluated the effects of clonidine on symptoms and anorectal sensorimotor funCtions in FI. Our hypotheses were that clonidine will improve symptoms and anorectal sensorimotor dysfunctions in women with urge-predominant FI.
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