Credit: Unsplash / Li Lin
Approximately 1 in 10 people without organic comorbidities related to bowel function reported fecal incontinence, according to a new study. Data suggests that irritable bowel syndrome (IBS) and constipation are the factors that most influence the risk of fecal incontinence, but the likelihood of receiving specialist treatment for these symptoms is lower than that of gastric disease. It depends on the background.1
A new analysis of the general Chinese population suggests disparities in the clinical characteristics of patients diagnosed and treated with fecal incontinence, particularly IBS-related fecal incontinence. Researchers led by Weiwei Zhang, from the Department of Colorectal Surgery at Changhai Hospital, proposed a more comprehensive assessment of defecation disorders in patients to distinguish between the presence and absence of IBS and constipation.
Zhang et al sought to compare the prevalence and symptoms of isolated fecal incontinence and fecal incontinence associated with IBS or constipation. They also looked to compare symptoms of bowel dysfunction, severity of fecal incontinence, and patient strategies for managing disease recurrence among the three observed cohorts.
The research team found that although irritable bowel syndrome and constipation are well-established causes of fecal incontinence, patients who report involuntary fecal incontinence are typically not tested for either condition by most clinicians. It was pointed out that this had not been done.2
“As a result, these two possible causes of fecal incontinence remain largely unrecognized and untreated,” the researchers wrote. “Current treatments for functional fecal incontinence primarily focus on the symptoms rather than the underlying cause, which can lead to suboptimal or even worse outcomes. ”
The team’s cross-sectional, prospective analysis used data from the Chinese Defecation and Faecal Incontinence (DeFeC) questionnaire. The questionnaire includes questions addressing an individual’s incontinence, constipation, irritable bowel syndrome, symptoms and bowel habits. They excluded patients who reported organic diseases or procedures related to intestinal outcomes to ensure a non-complicated cohort.
The researchers included 3,450 respondents in the analysis. The average age of the participants was 40.5 years, but the main age of the participants was 18 to 34 years (38.4%). 1,607 (51.1%) were male and 72.9% lived in an urban environment.
Zhang et al. observed fecal incontinence in 329 participants (10.5%). IBS was prevalent in 256 (8.2%) patients. and constipation was prevalent in 588 (18.7%) participants.
Among the incontinent patients, 106 (32.2%) had IBS-related diseases, 119 (36.2%) had constipation-related diseases, and 104 (31.6%) had isolated fecal incontinence.
The median Wexner incontinence score was 0 in the general cohort and 7 in the fecal incontinence group. Patients with IBS-related incontinence reported the highest median Wexner score of the three patient subpopulations (9.3 vs. 7.7 and 5.3).
IBS was associated with a 12-fold increased odds of fecal incontinence (odds ratio) [OR], 12.55; 95% CI, 9.06 – 17.36). Constipation had a 4-fold increase in his odds (OR, 4.38; 95% CI, 3.27-5.85; P <.001.).
The researchers also noted that spicy food intake, a history of urban residence, and a BMI score of 24 or higher were each associated with increased odds of fecal incontinence. Factors such as age over 45, female gender, and daily fruit and vegetable intake were associated with lower odds.
Symptoms such as stool consistency, pain, and bloating varied between patients with and without IBS, constipation, and fecal incontinence. Approximately a quarter (24.7%) of patients with fecal incontinence did not seek help for their symptoms. Patients with IBS-related incontinence were the least likely to seek professional help.
Approximately half (50.2%) of patients with fecal incontinence were using antidiarrheal drugs. 9.1% used an adapted diet to control the disease and 7.3% used warm water to cleanse the rectum. The researchers noted that 56.3% of patients with constipation-related incontinence used antidiarrheal medications.
“Additionally, respondents with IBS-related fecal incontinence used more antidiarrheal medications and rectal irrigation than respondents with constipation-related fecal incontinence or isolated fecal incontinence,” the researchers wrote. writing.
The researchers concluded that their findings indicate that incontinence is particularly likely in IBS patients, and that the association with constipation, although less likely, remains significant.
“We emphasize the need for awareness, as approximately 3.8% of subjects without preexisting organic problems or anorectal changes experience fecal incontinence associated with constipation,” the researchers said. is writing. “Importantly, these subjects should receive treatment on time to prevent the development of more severe constipation-related fecal incontinence, which may be irreversible in some cases.”
Although the evaluation was limited by the format of the online questionnaire and the potential influence of medications on patient responses, the team believes the study results indicate a relatively high prevalence of IBS-related, constipation-related, and isolated fecal incontinence in the general population. It was concluded that this indicates that the
“More than half of respondents with constipation-related fecal incontinence use antidiarrheal medications. “This shows that providing individualized care is important,” the researchers wrote. “This knowledge provides a basis for future research into the effectiveness of treatments when treating the causes, not just the symptoms, of fecal incontinence.”