Evaluation Of Clonidine In The Management Of Fecal Incontinence: A Placebo-Controlled Trial In Women With Diarrhea-Predominant Symptoms

Abstract

The other women with the urge-predominant fecal incontinence (FI) demonstrate the presence of diarrhea-predominant irritable bowel syndrome and binding and sensitive rectum. This was a prospective placebo controlled study that attempted to establish the effect of the use of the cloning 2-adrenergic agonist on the anorectal activity as well as the symptoms of female FI. The bowel and the anorectal functions were measured in a sample group of 43 women (mean age 58+/-2 years) with urge-prevalent FI who were randomized to take either clonidine (0.1 mg, twice a day) in tablet format or the placebo by mouth over a 4-week period taking into consideration the symptoms of the bowel and the anorectal functions measuring the anal pressures, the rectal compliance and sensation. The rectal compliance and sensation manometry helps to obtain the anal pressures before and after the treatment to terminate the measurements. Analysis was done by consulting the endoanal magnetic resonance imaging of the damage of the anal sphincter. Bowel diaries were made on daily and week basis. The primary outcome measure was F I and Constipation Assessment symptom severity score. The Placebo group reduced their FI scores of 9.1 0.3 to 7.6 0.5 compared with clonidine group which reduced their FI scores of 8.1 0.4 to 6.5 0.6. Clonidine had no effect on the severity of the symptoms of the FI and bowel symptoms (frequency of bowel movement or stool consistency), the anal pressures, rectal compliance, and sensation in comparison with the placebo. Nevertheless, when the subjects in a study were stratified in terms of those with and those without diarrhea, the percentage of loose stool between those who had diarrhea was decreased with the administration of clonidine (P=.018). It also minimized the days of FI in the sub sample of diarrhea (P=.0825).  Overall, clonidine showed no signs of improvement in bowel symptomatology, fecal bowel continence, and anorectal servages in women with urge-predominant FI over the placebo. But in subjects that had diarrhea, clonidine enhanced the consistency of stool and had a close significant positive impact on the fecal continence.