Examining racial disparities in counseling about sacral neuromodulation for men and women with idiopathic fecal incontinence.

Abstract

Background: Black patients undergo sacral neuromodulation for urinary incontinence less than White patients. There is less known about racial disparities in fecal incontinence.

Objective: To determine if racial disparities in fecal incontinence care exist, specifically sacral neuromodulation education.

Design: This was a retrospective cohort study of adults treated for fecal incontinence from 2011 to 2021 at an academic health center.

Settings: Medical records were queried to collect clinical variables, including diagnostic tests ordered, treatments offered or discussed, and specialties treating the patients' fecal incontinence.

Patients: The two cohorts were patients who identified as non-Hispanic Black or non-Hispanic White.

Main outcome measures: The primary outcome was the percent of patients with documentation of discussion of sacral neuromodulation.

Results: 180 Black patients and 360 age-matched White patients were included. 21.7% of patients with fecal incontinence had documented counseling about sacral neuromodulation which was significantly less frequent in Black patients (12.8% vs 26.1%, p < 0.001). However, among only patients with this counseling documented, there was no difference based on race (17.4% vs 21.3%, p = 0.679). Black patients were also less likely to receive referrals for pelvic floor physical therapy (52.2% vs 72.2%, p < 0.001), anorectal manometry (41.1% vs 51.9%, p = 0.018), sphincter imaging (1.1% vs 5.3%, p = 0.018), and defecography (7.2% vs 16.1%, p = 0.004). Patients seen by Urogynecology, Colorectal Surgery, and/or Urology were more likely to be counseled about sacral neuromodulation (48.4% vs 2.8%, p < 0.001). On multivariate logistic regression, Black race (OR 0.45 95% CI 0.25-0.81), male sex (OR 3.15 95% CI 1.33-7.41), and not seeing a surgical specialist (OR 0.03 95% CI: 0.01-0.06) were associated with no sacral neuromodulation counseling.

Limitations: Limitations include reliance on chart documentation for the primary outcome.

Conclusion: Racial differences in treatment of fecal incontinence exist between Black and White patients, including differences in counseling about sacral neuromodulation.