Alba Raventós, Silvia Carrión, Daniel Españó, Cristina Bascompte, Tennekoon Buddhika Karunaratne, Pere Clavé, Lluís Mundet
{"title":"Prevalence and Pathophysiology of Loose Stools and Their Impact on Clinical Severity and Quality of Life in Women With Fecal Incontinence.","authors":"Alba Raventós, Silvia Carrión, Daniel Españó, Cristina Bascompte, Tennekoon Buddhika Karunaratne, Pere Clavé, Lluís Mundet","doi":"10.1097/MCG.0000000000002095","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Background: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MCG.0000000000002095","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
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.
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.