From the AGA Journals

One in seven Americans had fecal incontinence

Publish date: May 1, 2018
By
Amy Karon
MDedge News

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An important step forward

Fecal incontinence (FI) is a common problem associated with significant social anxiety and decreased quality of life for patients who experience it. Unfortunately, patients are not always forthcoming regarding their symptoms, and physicians often fail to inquire directly about incontinence symptoms.

Previous studies have shown the prevalence of FI to vary widely across different populations. Using novel technology through a mobile app, researchers at the University of Michigan, Ann Arbor, and Cedars-Sinai Medical Center, Los Angeles, have been able to perform the largest population-based study of community-dwelling Americans. They confirmed that FI is indeed a common problem experienced across the spectrum of age, sex, race, and socioeconomic status and interferes with the daily activities of more than one-third of those who experience it.

This study supports previous findings of an age-related increase in FI, with the highest prevalence in patients over age 65 years. Interestingly, males were more likely than female to have experienced FI within the past week, but not more likely to have ever experienced FI. While FI is often thought of as a primarily female problem (related to past obstetrical injury), it is important to remember that it likely affects both sexes equally.

Other significant risk factors include diabetes and gastrointestinal disorders. This study also confirms prior population-based findings that patients with chronic constipation are more likely to suffer FI. Finally, this study also identified risk factors associated with FI symptom severity including diabetes, HIV/AIDS, Crohn’s disease, celiac disease, and chronic constipation. This is also the first study to show differences between racial/ethnic groups, suggesting higher FI symptom scores in Latinos and African-Americans.

The strengths of this study include its size and the anonymity provided by an internet-based survey regarding a potentially embarrassing topic; however, it also may have led to the potential exclusion of older individuals or those without regular internet access.

In summary, I believe this is an important study which confirms that FI is a common among Americans while helping to identify potential risk factors for the presence and severity of FI. I am hopeful that with increased awareness, health care providers will become more prudent in screening their patients for FI, particularly in these higher-risk populations.

Stephanie A. McAbee, MD, is an assistant professor of medicine in the division of gastroenterology, hepatology, and nutrition at Vanderbilt University Medical Center, Nashville, Tenn. She has no conflicts of interest.


 

FROM GASTROENTEROLOGY

One in seven respondents to a national survey reported a history of fecal incontinence, including one-third within the preceding week, investigators reported.

“Fecal incontinence [FI] is age-related and more prevalent among individuals with inflammatory bowel disease, celiac disease, irritable bowel syndrome, or diabetes than people without these disorders. Proactive screening for FI among these groups is warranted,” Stacy B. Menees, MD, and her associates wrote in the May issue of Gastroenterology (doi: 10.1053/j.gastro.2018.01.062).

Accurately determining the prevalence of FI is difficult because patients are reluctant to disclose symptoms and physicians often do not ask. In one study of HMO enrollees, about a third of patients had a history of FI but fewer than 3% had a medical diagnosis. In other studies, the prevalence of FI has ranged from 2% to 21%. Population aging fuels the need to narrow these estimates because FI becomes more common with age, the investigators noted.

Accordingly, in October 2015, they used a mobile app called MyGIHealth to survey nearly 72,000 individuals about fecal incontinence and other GI symptoms. The survey took about 15 minutes to complete, in return for which respondents could receive cash, shop online, or donate to charity. The investigators assessed FI severity by analyzing responses to the National Institutes of Health FI Patient Reported Outcomes Measurement Information System questionnaire.

Of the 10,033 respondents reporting a history of fecal incontinence (14.4%), 33.3% had experienced at least one episode in the past week. About a third of individuals with FI said it interfered with their daily activities. “Increasing age and concomitant diarrhea and constipation were associated with increased odds [of] FI,” the researchers wrote. Compared with individuals aged 18-24 years, the odds of having ever experienced FI rose by 29% among those aged 25-45 years, by 72% among those aged 45-64 years, and by 118% among persons aged 65 years and older.

Self-reported FI also was significantly more common among individuals with Crohn’s disease (41%), ulcerative colitis (37%), celiac disease (34%), irritable bowel syndrome (13%), or diabetes (13%) than it was among persons without these conditions. Corresponding odds ratios ranged from about 1.5 (diabetes) to 2.8 (celiac disease).

For individuals reporting FI within the past week, greater severity (based on their responses to the NIH FI Patient Reported Outcomes Measurement Information System questionnaire) significantly correlated with being non-Hispanic black (P = .03) or Latino (P = .02) and with having Crohn’s disease (P less than .001), celiac disease (P less than .001), diabetes (P = .04), human immunodeficiency syndrome (P = .001), or chronic idiopathic constipation (P less than .001). “Our study is the first to find differences among racial/ethnic groups regarding FI severity,” the researchers noted. They did not speculate on reasons for the finding, but stressed the importance of screening for FI and screening patients with FI for serious GI diseases.

Ironwood Pharmaceuticals funded the National GI Survey, but the investigators received no funding for this study. Three coinvestigators reported ties to Ironwood Pharmaceuticals and My Total Health.

SOURCE: Menees SB et al. Gastroenterology. 2018 Feb 3. doi: 10.1053/j.gastro.2018.01.062.

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