Fecal Incontinence Reduces Quality of Life More Than You May Think

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Fecal incontinence (FI), the inability to control liquid and/or solid stool, is a common problem affecting more than 1 in 8 adults in northern Queensland.1 Since 2002, the Townsville Hospital anorectal biofeedback program has provided treatment for bowel disorders. The biofeedback therapist advised that, posttreatment, patients would often report that they underestimated the pretreatment effect of FI on their quality of life (QoL); this anecdotal information warranted investigation.
Sixty-two participants from an earlier randomized controlled trial2 were recruited to recall their QoL pretreatment using the validated Fecal Incontinence Quality of Life Scale survey.3 Baseline and recalled Fecal Incontinence Quality of Life Scale scores were compared.
Fifty-one participants (median age, 61 y (40 women)) responded (82.2%), a median 82 months after treatment. FI duration before treatment was 24 months (interquartile range, 18–87 mo). Recalled pretreatment Fecal Incontinence Quality of Life Scale responses (median = 72/119 (interquartile range, 46–94)) were significantly worse than their actual pretreatment responses (median = 80.2/119 (interquartile range, 64–97); p = 0.03; Fig. 1). Specifically, FI had a constraining effect on their lifestyle (p = 0.001) and was more depressing (p = 0.004) than reported at baseline.
Recalled pretreatment QoL was 8.2% worse than actual pretreatment. Participants completed treatment 82 months before responding; therefore, there may be recall bias. People with FI underestimate its effect on their QoL; this is important for those with the debilitating condition, their carers, and clinicians. We believe that this underestimation could be because of the stigma associated with FI. Clinicians should, therefore, treat FI promptly, regardless of severity, to minimize the effect of this chronic condition on a person’s QoL.
The authors thank Kathryn Sloots, biofeedback therapist,for her original observation, which prompted this investigation.
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