Issue 08

Clinical Question

In Crohn’s disease (CD), how prevalent is fecal incontinence (FI), and can clinicians identify patients at high-risk?

Editor’s Bottom Line

Clinicians treating CD should ask about FI. It is common, and compromises quality of life.

Reference

Vollebregt PF, Visscher AP, van Bodegraven AA, et al. Validation of risk factors for fecal incontinence in patients With Crohn’s disease. Dis Colon Rectum. 2017 Aug;60(8):845–51. https://www.ncbi.nlm.nih.gov/pubmed/28682970

Synopsis

Questionnaires were sent to patients with CD identified in a Dutch academic hospital database. Medical records were reviewed to collect medical and surgical histories, medication use, obstetric history, and sociodemographic information. The questionnaire collected information regarding perianal disease, fecal incontinence, and quality of life, using the Fecal Incontinence Quality of Life survey. Risk factors for FI were assessed via univariate and multivariate analyses.

For the 325 respondents (median age 42 years; M:F, 3:5), the median time from diagnosis of CD was 12 years. Of the 109 women with children, 76% of deliveries were either traumatic or involved instruments. Medications used when the questionnaire was completed were: thiopurines (37%), anti-TNFs (17%), and methotrexate (6%). A total of 42% had previous bowel resections for luminal disease. Fistula surgery was reported by 30% while 27% had perianal abscess and surgery. FI to liquid or solid stool was reported by 20% of participants, while 9% were incontinent only to gas. In univariate analysis, FI within the previous 4 weeks was associated with age, Montreal classification A and B, liquid stools, previous bowel resection, and perianal disease. In multivariate regression, only liquid stools, stricturing, and perianal disease were significant risk factors for FI (P<0.0001, P=0.02, and P=0.03, respectively). More frequent episodes of FI (≥2 weekly) significantly decreased quality of life.

Details

Study Design: Prospective cohort study
Funding: None
Allocation: n/a
Setting: Amsterdam
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.