Trans-Anal Irrigation in Patients with Multiple Sclerosis: Efficacy in Treating Disease-Related Constipation and Faecal Incontinence, and Impact on the Gut Microbiota. A Monocentric Prospective Study.

Constipation and fecal incontinence are common in patients with Multiple Sclerosis (MS), impairing quality of life (QoL). The gut microbiota (GM) is altered in MS patients and likely contributes to disease pathogenesis. Trans-anal irrigation (TAI) has been proven to allow treatment of neurogenic bowel dysfunction and may affect GM. The primary outcome was TAI effectiveness on constipation and fecal incontinence. The secondary outcome was GM profiling compared to healthy subjects and during TAI adoption. We conducted a prospective cohort study on MS patients, screened with PAC-QoL questionnaire before undergoing constipation and fecal incontinence scoring, abdomen X-ray for intestinal transit time, compilation of food and evacuation diaries, and fecal sample collection for GM analysis before and after 4 weeks of TAI. Eighty patients were screened of which nearly half had intestinal symptoms. The included population (n=37) was predominantly composed of women with significantly longer disease duration, higher meanage and disability than the excluded one (p<0.05). Twelve patients completed the TAI phase, which led to significant improvement of bowel dysfunction symptom-related QoL, increase of GM diversity, and reduction of the proportions of pro-inflammatory taxa (p<0.05). TAI was safe, satisfactory, and could help counteract MS-related dysbiosis.