Faecal incontinence in inflammatory bowel disease: Associations and effect on quality of life☆

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Background and aims: No previous study has reported on faecal incontinence (FI) amongst people with IBD. We aimed to determine the frequency and severity of FI in people with IBD, its association with known FI risk factors, and the effect on quality of life.

Method: We randomly sampled 10,000 members of a national Crohn's and Colitis organisation over 18 years old. Demographic information, medical history, FI (ICIQ-B), urinary continence (ICIQ-UI), quality of life (IBD-Q) and free text responses about FI were collected. Current disease activity was reported using the Harvey Bradshaw Index for Crohn's Disease (CD), and the Walmsley Index for ulcerative colitis (UC). Data were managed using Excel, Stata and SPSS 18.

Results: 4827 responses were received: 3264 were complete and included (32.6% response). 2178 respondents were female (66.7%); mean age 50.26 yrs (range 19–92); CD 1543 (46.98%); UC 1599 (48.97%); other IBD 126 (3.85%); no diagnosis given 6 (0.18%).

74% (2391) of respondents reported FI (95% CI 72–75). Nine percent (299) reported regular FI. No association was found between FI and diagnosis. Significant associations were found in multivariable analysis between FI and age (p = 0.005), gender (p < 0.001), anal stretch (p = 0.004), anal fistula surgery (p < 0.001), colo-rectal surgery (p = < 0.001), and urinary incontinence (p = < 0.001), but not with vaginal delivery. Quality of life was significantly affected by FI (p < 0.001).

Conclusion: Even if all non-respondents are continent, FI affects 24% of people with IBD. In our sample 74% reported FI, which can occur without active disease. There is a large currently unmet need for continence care in people with IBD.

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