Understanding the patient perspective for treatment outcomes and preferences in functional bowel disorders

Functional bowel disorders, including irritable bowel syndrome (IBS), constipation and fecal incontinence, are very common in the population. Due to recurrent and persistent abdominal pain and/or stool problems, these patients have a lower quality of life and a high consumption rate of healthcare. Multiple effective treatments are available for these conditions. Nevertheless, as no single treatment works for all patients and symptoms differ per patient, the search for a suitable treatment remains a challenge. This thesis therefore examined the treatment preferences in IBS patients. These studies showed that patients preferred dietary intervention, subsequently medication and psychological treatment. In addition, the long-term outcomes of various surgical procedures for constipation and fecal incontinence were examined, when treatment with medication is no longer effective. The results of the Malone stoma (artificial access to the large intestines) and the artificial bowel sphincter were disappointing because of little effect on the complaints and the presence of many complications. Sacral neuromodulation did show promising results. Shared decision-making is therefore important when choosing a treatment, whereby the wishes and expectations of patients with functional abdominal complaints should be thoroughly discussed.