The effects of clonidine on symptoms and anorectal sensorimotor function in women with faecal incontinence

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.