Background: Faecal incontinence (FI) has a great impact on daily (quality of) life and many patients are too embarrassed to report it spontaneously. Prevalence of FI in patients with Crohn's disease (CD) has barely been studied and little is known about factors predicting FI in these patients. To estimate its prevalence and evaluate potential causes in patients with complex CD, we studied a tertiary CD population and related outcome with quality of life.
Methods: Consecutive patients with CD treated between 2003 and July 2013 at our centre were identified in the prospectively maintained departments' IBD-database. A questionnaire was sent out in October 2013 to evaluate current complaints of FI, perianal disease and the Faecal Incontinence Quality of Life questionnaire. Demographic characteristics and medical history were collected by use of the IBD-database and additional chart review. Multivariate regression analysis was performed.
Results: The questionnaire was responded by 325 out of 528 patients (62%). Median age of patients was 42 years (range 18–91), 215 (66%) were female and diagnosis of CD was established for a median period of 12 years (interquartile range 6–21). FI was reported by 65 patients (20%), median St. Marks Incontinence score was 11. FI was associated with liquid stools (p=0.0001), previously performed IBD-related bowel resections (p=0.001), stricturing behaviour of disease (p=0.02) and perianal disease (p=0.03). Quality of life (lifestyle, coping, depression, embarrassment) was poor in patients with FI, particularly in patients with more frequent episodes of incontinence.
Conclusions: Prevalence of FI in a tertiary CD population is substantially higher than in the community-dwelling population. Considering the reduced quality of life in incontinent patients, active questioning to identify FI is recommended in those with liquid stools, perianal disease or previous (intestinal or perianal) surgery. Multimodality treatment is proposed due to the high impact on quality of life.