This was a prospective study undertaken in one hospital providing secondary and tertiary care. Patients with ulcerative colitis (UC), Crohn’s disease or an ileoanal pouch and symptoms of fecal urgency, fecal incontinence, or constipation (reduced defecation frequency or difficulty with evacuation) were referred by gastroenterologists and screened for inclusion.
Patients included were ≥ 18 years with quiescent IBD, based on a disease activity score and fecal calprotectin, endoscopy, or imaging. Exclusion criteria were significant medical or psychiatric comorbidity, alcohol or drug abuse, inability to understand English, pregnancy, and previous pelvic floor muscle training.
Patients had two to six sessions, at monthly intervals, of physiotherapist-led behavioral treatment which included: education regarding anatomy and function of the bowel and the muscles involved in continence and defecation; specific exercises to improve muscle function and coordination (diaphragm, abdominal, anal and pelvic floor) with or without biofeedback (digital, real-time ultrasound, rectal balloon); modification of maladaptive toileting behavior (prolonged or repeated toileting attempts, straining, digitation); urge control strategies, lifestyle advice on regular eating, stress management and general exercise; practical management strategies including perianal skincare and continence aids, and a home exercise program.
Patient-reported symptom improvement after treatment was rated on a seven-point Likert scale (0 = substantially worse, 7 = substantially better). The primary outcome was the percentage of patients reporting a Likert score of 6 or 7 (moderately or substantially better), post-treatment, considered to indicate significant clinical response .
Secondary outcomes, assessed before and at the end of treatment, included the St Mark’s (Vaizey) fecal incontinence score (FIS), the patient assessment of constipation symptoms (PAC-SYM), the inflammatory bowel disease questionnaire (IBDQ) for disease-specific quality of life, and the short-form 36 (SF-36) and EuroQol (EQ-5D) for general quality of life. Psychological factors were assessed with the hospital anxiety and depression scale (HADS), the brief illness perception questionnaire (BIPQ) and the IBD self-efficacy scale (IBD-SES).