Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment.

Anorectal physiology Constipation Faecal incontinence Pelvic floor dysfunction

Journal

EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727

Informations de publication

Date de publication:
Oct 2020
Historique:
received: 08 06 2020
revised: 02 09 2020
accepted: 14 09 2020
entrez: 5 11 2020
pubmed: 6 11 2020
medline: 6 11 2020
Statut: epublish

Résumé

In contrast to paediatric and geriatric populations, faecal incontinence and constipation in adults are generally considered separate entities. This may be incorrect. Cross-sectional study of consecutive patients (18-80 years) referred to a tertiary unit (2004-2016) for investigation of refractory faecal incontinence and/or constipation and meeting Rome IV core criteria (applied post-hoc) for self-reported symptoms. We sought to determine how frequently both diagnoses coexisted, how frequently coexistent diagnoses were recognised by the referring clinician and to evaluate differences in clinical characteristics between patients with single or both diagnoses. Study sample consisted of 4,027 patients (3,370 females [83·7%]). According to Rome IV criteria, 807 (20·0%) patients self-reported faecal incontinence in isolation, 1,569 (39·0%) patients had functional constipation in isolation, and 1,651 (41·0%) met criteria for both diagnoses (coexistent symptoms). In contrast, only 331 (8·2%) patients were referred for coexistent symptoms. Of the 1,651 patients with self-reported coexistent symptoms, only 225 (13·6%) were recognised by the referrer i.e. 86·4% were missed. Coexistent symptoms were most often missed in patients referred for faecal incontinence in isolation. In this group of 1,640 patients, 765 (46·7%) had concomitant symptoms of functional constipation. Opioid usage, comorbidities, childhood bowel problems, mixed incontinence symptoms, prolapse symptoms and structural abnormalities on defaecography were associated with reclassification. Over 40% of adults referred for anorectal physiological investigation had coexistent diagnoses of faecal incontinence and functional constipation, based on validated criteria. This overlap is overlooked by referrers, poorly documented in current literature, and may impact management.

Sections du résumé

BACKGROUND BACKGROUND
In contrast to paediatric and geriatric populations, faecal incontinence and constipation in adults are generally considered separate entities. This may be incorrect.
METHODS METHODS
Cross-sectional study of consecutive patients (18-80 years) referred to a tertiary unit (2004-2016) for investigation of refractory faecal incontinence and/or constipation and meeting Rome IV core criteria (applied post-hoc) for self-reported symptoms. We sought to determine how frequently both diagnoses coexisted, how frequently coexistent diagnoses were recognised by the referring clinician and to evaluate differences in clinical characteristics between patients with single or both diagnoses.
FINDINGS RESULTS
Study sample consisted of 4,027 patients (3,370 females [83·7%]). According to Rome IV criteria, 807 (20·0%) patients self-reported faecal incontinence in isolation, 1,569 (39·0%) patients had functional constipation in isolation, and 1,651 (41·0%) met criteria for both diagnoses (coexistent symptoms). In contrast, only 331 (8·2%) patients were referred for coexistent symptoms. Of the 1,651 patients with self-reported coexistent symptoms, only 225 (13·6%) were recognised by the referrer i.e. 86·4% were missed. Coexistent symptoms were most often missed in patients referred for faecal incontinence in isolation. In this group of 1,640 patients, 765 (46·7%) had concomitant symptoms of functional constipation. Opioid usage, comorbidities, childhood bowel problems, mixed incontinence symptoms, prolapse symptoms and structural abnormalities on defaecography were associated with reclassification.
INTERPRETATION CONCLUSIONS
Over 40% of adults referred for anorectal physiological investigation had coexistent diagnoses of faecal incontinence and functional constipation, based on validated criteria. This overlap is overlooked by referrers, poorly documented in current literature, and may impact management.

Identifiants

DOI: 10.1016/j.eclinm.2020.100572 PMID: 33150331 PMC: PMC7599308
pubmed: 33150331
doi: 10.1016/j.eclinm.2020.100572
pii: S2589-5370(20)30316-3
pmc: PMC7599308
doi:

Types de publication

Journal Article

Langues

eng

Pagination

100572

Informations de copyright

© 2020 The Authors.

Déclaration de conflit d'intérêts

Paul F Vollebregt, Lukasz Wiklendt and Phil G Dinning have no conflict of interest. Charles H Knowles has received financial remuneration from Medtronic Inc. as speaker fees and for expert advisory committees, and research support from Saluda Medical. S Mark Scott has received honoraria for teaching from MMS/Laborie.

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Auteurs

Paul F Vollebregt (PF)

National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.

Lukasz Wiklendt (L)

College of Medicine and Public Health, Flinders University, Australia.

Phil G Dinning (PG)

College of Medicine and Public Health, Flinders University, Australia.
Department of Gastroenterology, Flinders Medical Centre, Australia.

Charles H Knowles (CH)

National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.

S Mark Scott (SM)

National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.

Classifications MeSH