Background: Fecal incontinence (FI) significantly affects patient’s quality of life and leads to psychosocial distress. While the disease is historically considered to be female predominant, there is limited information regarding the influence of gender on FI severity, psychosocial traits, and quality of life.
Aim: To evaluate the role of gender on influencing the severity of FI and associated psychosocial distress, using validated FI questionnaires across multiple centers in USA.
Methods: Patients with FI (≥1 episode/week) who completed a 2-week FI stool diary APP and enrolled in a multicenter NIH clinical trial of neuromodulation therapy participated. They completed questionnaires that examined FI severity using several scales: FI severity score (FISS:(4(mild) to 13(severe), FI severity index (FISI: 0(no leakage) to 61 (severe)), and International Consultation on Incontinence Questionnaire Bowel Leakage (ICIQ-B) that assessed three domains (bowel pattern (0 to 21 (severe), bowel control (0 to 28 (severe), and quality of life (0 to 26 (severe)). The FI- QOL assessed the changes in QOL in 8 domains, including effects on lifestyle, coping, embarrassment, and depression (lower score indicates worse outcome). The differences between females and males were compared.
Results: We evaluated data from 157 subjects (F/M=125/32, 62.5±11.7 yrs.) with FI. There was no difference in education level, duration of symptoms and bowel symptoms related to FI, including the frequency of FI episodes/Week, Bowel movements (BMs)/Week, mean stool consistency (BSFS scale) between females and males (p>0.1477). The use of pads and percentage of BMs with urgency, were higher in females (p<0.0158, table 1). Females reported significantly worse FI symptoms, with higher scores of FISS and ICIQ-B bowel control (p<0.0159). Scores for FISI and ICIQ-B bowel pattern were also worse in females, although not significantly (p<0.058). The impact of FI on quality of life was higher in females than males regarding lifestyle, coping, depression, and embarrassment (p<0.0703).
Conclusion: Our study demonstrates that women with FI generally have more severe illness as assessed by standardized tools. Also, FI has a more profound impact on the quality of life in females when compared to males. These findings may explain why more women with FI tend to seek health care when compared to men, although the prevalence of FI in community surveys appears to be generally similar.
Acknowledgement: NIDDK R01-DK057100-05 grant

Deepak Ayyala

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