Irritable Bowel Syndrome, Fecal Incontinence and Quality of Life: It Depends on How You Think About It

Abstract

Introduction: Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder characterized by recurrent abdominal pain and altered bowel habits. IBS is a risk factor for fecal incontinence (FI), the unintentional passage of solid or liquid stool. FI can substantially interfere with quality of life, leading to heightened anxiety and avoidance behavior. Nevertheless, relatively little research has been conducted on the prevalence of FI in IBS patients. This study evaluated the prevalence of FI in a large sample of IBS patients and the relationship between FI and quality of life. Methods: A total of 703 patients who reported a diagnosis of IBS completed questionnaires on IBS symptom severity, FI symptom severity, health related quality of life (HRQL), fear of food, anxiety about visceral sensations, and GI specific catastrophizing. Results: Overall, 60% of patients with IBS reported experiencing at least one lifetime episode of FI. In a subsample of 360 patients who met strict Rome IV criteria and reported no other GI related co-morbidities, 62% reported experiencing at least one lifetime episode. While IBS patients who experienced FI more frequently had worse HRQL statistically, the differences in HRQL between patients who had experienced FI and those who had not were not clinically significant. Rather than frequency of FI or physical symptom severity, quality of life was mostly determined by psychological variables, such as fear of food, anxiety, and catastrophizing. Conclusion: This study suggests that FI is quite prevalent in IBS patients, but that the best way to improve HRQL for IBS patients with FI may be to focus on reducing anxiety, catastrophizing and avoidance.