Fecal Incontinence is Highly Associated with IBS or Constipation

Credit: Unsplash / Li Lin

Approximately 1 in 10 persons without organic comorbidities linked to defecation function reported fecal incontinence, according to new research. The data suggest that irritable bowel syndrome (IBS) and constipation are far and away the most impactful drivers of fecal incontinence risk, though the likelihood of seeking specialist care for their condition was varied based on gastric disease background.¹

A new analysis of the general Chinese population implicates disparities in the clinical characteristics of patients diagnosed with and treated for fecal incontinence, especially as it relates to IBS. The investigators, led by Wei Zhang, of the department of colorectal surgery at Changhai Hospital, advocated for a more comprehensive evaluation of defecation disorders in patients to distinguish its presence with or without IBS or constipation.

Zhang and colleagues sought to compare the prevalence and symptoms of isolated fecal incontinence versus IBS- or constipation-associated fecal incontinence. They additionally looked to compare the symptoms of bowel dysfunction between the 3 observed cohorts, as well as the severity of fecal incontinent and patients’ strategies for managing their iteration of disease.

The team noted that though IBS and constipation are well-established causes of fecal incontinence, patients reported an involuntary loss of feces are not generally examined for either condition by most clinicians.²

“As a result, these two possible causes of fecal incontinence remain largely unrecognized and untreated,” investigators wrote. “The current treatment of functional fecal incontinence mainly focuses on symptoms instead of the underlying causes, which may contribute to suboptimal outcomes or even worsen the outcomes.”

The team’s cross-sectional, prospective analysis used data from the Chinese Defecation and Fecal Continence (DeFeC) questionnaire, that which contains questions corresponding to individuals’ continence, constipation and IBS, as well as their symptoms and defecation habits. They excluded patients who reported having organic diseases or procedures associated with bowel outcomes to ensure a non-comorbidity cohort.

Investigators included 3450 respondents in their analysis. Mean participant age was 40.5 years old, though participants were primarily 18 – 34 years old (38.4%); 1607 (51.1%) were male, and 72.9% lived in a city setting.

Zhang and colleagues observed fecal incontinence in 329 (10.5%) participants; IBS was prevalent in 256 (8.2%) patients; and constipation was prevalent in 588 (18.7%) participants.

Of patients with incontinence, 106 (32.2%) had IBS-associated disease, 119 (36.2%) had constipation-associated disease, and 104 (31.6%) had isolated fecal incontinence.

Median Wexner incontinence score was 0 among the general cohort and 7 among the fecal incontinence group. Patients with IBS-associated incontinence reported that greatest median Wexner scores among the 3 patient sub-populations (9.3 vs 7.7 and 5.3).

IBS was associated with 12-fold increased odds of fecal incontinence (odds ratio [OR], 12.55; 95% CI, 9.06 – 17.36). Constipation was associated with 4-fold increased odds (OR, 4.38; 95% CI, 3.27 – 5.85; P <.001.).

Investigators additionally noted that increased spicy food intake, city residency, and body mass index (BMI) scores ≥24 were each associated with increased odds for fecal incontinence. Factors including age ≥45 years old, female gender and consumption of daily fruits and vegetables were associated with lower odds.

Fecal consistency and symptoms including pain or bloating were disparate among patients with or without IBS or constipation and fecal incontinence. Approximately one-quarter (24.7%) of patients with fecal incontinence did not seek help for their condition; patients with IBS-associated incontinence were the least likely to seek a specialist’s help.

Approximately half (50.2%) of patients with fecal incontinence used anti-diarrhea medicine; 9.1% used an adapted diet to control their disease and 7.3% used warm water to irrigate the rectum. Investigators noted that 56.3% of patients with constipation-associated incontinence used anti-diarrhea medicine.

“Moreover, IBS-associated fecal incontinence respondents used more anti-diarrhea medication and rectal irrigation than constipation-associated fecal incontinence respondents and respondents with isolated fecal incontinence,” they wrote.

The team concluded their findings show a high likelihood of incontinence particularly among patients with IBS, with less likely but still significant association with constipation as well.

“We emphasize the need for awareness, as approximately 3.8% of subjects without organic problems or without already recognized anorectal alterations experienced constipation-associated fecal incontinence,” they wrote. “Importantly, these subjects should be provided with treatment on time to prevent the development of more severe forms of constipation-associated fecal incontinence, which, in some cases, can even be irreversible.”

Though the assessment was limited by its online questionnaire format as well as the potential influence of medication on patients’ answers, the team concluded their findings show a comparably high prevalence of IBS-associated, constipation-associated and isolated fecal incontinence in the general population.

“More than half of constipation-associated fecal incontinence respondents use anti-diarrheal medicines, indicating the importance of diagnosing and targeting the cause of FI to provide personalized care instead of addressing only the fecal incontinence symptoms,” they wrote. “This knowledge provides the fundament for future research on treatment efficacy when the cause of fecal incontinence, instead of only the symptom, is treated.”