Prevalence and Predictors of Bowel Incontinence: Results from a US Population-Based Study 2016 ACG Category Award (Functional Bowel Disease): 2016 ACG Presidential Poster Award

Abstract

Introduction: Fecal incontinence (FI) is a prevalent disorder characterized by the uncontrolled passage of solid or liquid stool. The aim of this study was to determine the prevalence and predictors of FI in a large, representative sample of community-dwelling Americans. Methods: To evaluate the burden of gastrointestinal (GI) illness in the US, we conducted the National GI Survey in October 2015 using MyGiHealth, a mobile app that systematically collects patient GI symptoms. We partnered with Cint®, a survey research firm, to recruit a representative sample of Americans to complete MyGiHealth. MyGiHealth guided participants through NIH GI Patient Reported Outcome Measurement Information System (PROMIS®) surveys and questions about relevant comorbidities and demographics. FI was defined as accidental leakage of solid or liquid stool within the last seven days. Our primary and secondary outcomes were FI prevalence and FI severity (as determined by NIH PROMIS scores), respectively. Multivariable logistic and linear regression models were used to identify independent predictors of FI prevalence and severity, respectively. Results: Overall, 71,812 individuals completed the National GI Survey, of which 3,094 (4.3%) individuals reported FI. Older age, male gender and Hispanic ethnicity were demographic factors associated with a higher likelihood of FI (Table 1). Asian ethnicity reduced the likelihood of FI. Those who reported diarrhea or constipation in the last week, had Crohn's, ulcerative colitis, celiac disease (CD), irritable bowel syndrome and diabetes mellitus (DM) were all more likely to have FI. With respect to FI symptom severity, as determined by NIH PROMIS scores, more severe FI was seen among non-Hispanic blacks and Hispanics, whereas patients aged ≥65 years had less severe FI (Table 2). Participants who reported concomitant diarrhea, Crohn's, CD, DM, HIV/AIDS, and chronic idiopathic constipation also had more severe FI.Table 1: Predictors of having experienced bowel incontinence within the past 7 daysTable 1: Continued.Table 2: Factors associated with fecal incontinence severity by multivariable linear regressionTable 2: Continued.Conclusion: In this large population-based survey of community-dwelling Americans,FI prevalence was lower than prior estimates. FI is an age-related disorder found to be more prevalent in males and those of Hispanic ethnicity. Proactive screening for FI in Crohn's, CD, and DM is warranted and their presence is associated with more severe FI.