Prevalence and Pathophysiology of Loose Stools and Their Impact on Clinical Severity and Quality of Life in Women With Fecal Incontinence.

IF 2.8 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of clinical gastroenterology Pub Date : 2024-10-30 DOI:10.1097/MCG.0000000000002095
Alba Raventós, Silvia Carrión, Daniel Españó, Cristina Bascompte, Tennekoon Buddhika Karunaratne, Pere Clavé, Lluís Mundet
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Abstract

Objective: To compare the impact of fecal consistency with anorectal sphincter dysfunctions on clinical severity and quality of life (QoL) in women with fecal incontinence (FI).

Background: FI affects up to 24% of middle-aged women, significantly impacting their QoL. Pathophysiological studies have focused more on sphincter and anorectal dysfunctions than on the role of fecal consistency.

Patients and methods: A cross-sectional observational study evaluating anorectal physiology, neurophysiology, and fecal consistency with regard to clinical severity and QoL. Patients with a Bristol Stool Chart (BSC) score of 5 or more (BSC ≥5) underwent a breath test to detect bacterial overgrowth (small intestinal bacterial overgrowth), lactose or fructose/sorbitol malabsorption, and/or a cholestyramine test to detect bile acid malabsorption. We compared anorectal physiology, clinical severity, and QoL of those with BSC ≥5 with BSC <5.

Results: The study included 150 women with an average age of 64.81 ± 11.96. FI types varied: 64.38% had urge FI, 15.06% had passive FI, and 19.18% had both. Among them, 56.2% had BSC ≥5, linked to bile acid malabsorption (20.5%), lactose malabsorption (17.9%), small intestinal bacterial overgrowth (14.3%), and fructose/sorbitol malabsorption (14.3%). Anorectal dysfunctions were highly prevalent, with 49.1% showing external anal sphincter insufficiency, 9.8% internal, and 34.7% both. Those with BSC ≥5 experienced significantly worse clinical severity and QoL (St. Mark 17.3 ± 2.69 vs 12.9 ± 3.27), and more pronounced issues in Fecal Incontinence Quality of Life Scale dimensions of lifestyle, coping, depression, and EuroQol 5-dimension of anxiety/depression and pain/discomfort.

Conclusions: Fecal consistency of BSC ≥5 significantly worsens clinical severity and QoL in women with FI. Specific diagnostic and therapeutic approaches addressing loose stools are needed before any rehabilitation treatment.

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大便失禁妇女的患病率和病理生理学及其对临床严重程度和生活质量的影响。
目的比较粪便稠度和肛门直肠括约肌功能障碍对大便失禁(FI)女性临床严重程度和生活质量(QoL)的影响:背景:多达 24% 的中年女性患有大便失禁,严重影响了她们的生活质量。病理生理学研究更多地关注括约肌和肛门直肠功能障碍,而不是粪便稠度的作用:一项横断面观察研究,评估肛门直肠生理学、神经生理学和粪便稠度与临床严重程度和 QoL 的关系。布里斯托粪便图(BSC)评分为 5 分或 5 分以上(BSC ≥5)的患者接受呼气试验以检测细菌过度生长(小肠细菌过度生长)、乳糖或果糖/山梨醇吸收不良,和/或胆汁淤积试验以检测胆汁酸吸收不良。我们比较了 BSC≥5 和 BSC 结果者的肛门直肠生理学、临床严重程度和 QoL:研究共包括 150 名女性,平均年龄为(64.81 ± 11.96)岁。FI 类型各异:64.38%的人有急迫性 FI,15.06%的人有被动性 FI,19.18%的人两者都有。其中,56.2%的人 BSC ≥5,与胆汁酸吸收不良(20.5%)、乳糖吸收不良(17.9%)、小肠细菌过度生长(14.3%)和果糖/山梨醇吸收不良(14.3%)有关。肛门直肠功能障碍的发病率很高,49.1%的人显示肛门外括约肌功能不全,9.8%的人显示肛门内括约肌功能不全,34.7%的人同时显示肛门外括约肌功能不全和肛门内括约肌功能不全。BSC≥5者的临床严重程度和生活质量明显更差(St. Mark 17.3 ± 2.69 vs 12.9 ± 3.27),大便失禁生活质量量表中的生活方式、应对、抑郁以及EuroQol 5中的焦虑/抑郁和疼痛/不适等维度的问题也更明显:结论:BSC≥5的粪便浓度会明显加重FI妇女的临床严重程度和生活质量。在进行康复治疗之前,需要针对稀便采取具体的诊断和治疗方法。
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来源期刊
Journal of clinical gastroenterology
Journal of clinical gastroenterology 医学-胃肠肝病学
CiteScore
5.60
自引率
3.40%
发文量
339
审稿时长
3-8 weeks
期刊介绍: Journal of Clinical Gastroenterology gathers the world''s latest, most relevant clinical studies and reviews, case reports, and technical expertise in a single source. Regular features include cutting-edge, peer-reviewed articles and clinical reviews that put the latest research and development into the context of your practice. Also included are biographies, focused organ reviews, practice management, and therapeutic recommendations.
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