AUA 2018: Risk Factors Associated with Fecal Incontinence in Patients with Overactive Bladder

San Francisco, CA USA ( This session featured studies that evaluated conditions associated with urinary incontinence including obesity, fecal incontinence and depression. Fecal incontinence (FI) is associated with many pelvic floor disorders and has a devastating impact on quality of life. Many patients as well as clinicians are hesitant to discuss FI due to discomfort with the topic and lack of knowledge regarding its treatment. However, it is very important for physicians to address FI, as its treatments can be very effective and have a significant positive impact on quality of life. The authors here sought to evaluate the association of fecal incontinence with overactive bladder (OAB) severity and quality of life.

Community-based women were asked to complete questionnaires to evaluate for the presence of OAB and FI. FI was defined as any leakage of mucus, liquid, or solid stool occurring at least monthly. The presence of OAB was confirmed by a score of greater than or equal to 4 on the OABv3 screening questionnaire. OAB patients were evaluated for OAB severity using the OAB-q8 questionnaire. Quality of life and FI severity were assessed using the OAB-q SF and Fecal Incontinence Severity Index (FISI) respectively.

192 patients with OAB were identified, 53% of whom reported FI. As compared to those without FI, FI patients were older (46.8 vs 41.6). They also had a higher prevalence of neuropathy (12.8% vs 3.3%), disc disease (19.8% vs 6.6%), irritable bowel syndrome (34.7% vs 17.6%), fibromyalgia (10.9% vs 2.2%), and chronic fatigue syndrome (11.9% vs 3.3%). On questionnaire data, women with FI had more severe OAB, as well as worse OAB-related quality of life. OAB severity and OAB-related quality of life were significantly correlated to FI severity.

This was a very interesting study that highlighted the high prevalence of FI among OAB patients (53%). OAB patients with FI also had a higher propensity for chronic comorbid conditions. Not only did patients with FI have higher OAB severity, the severity of FI was significantly associated with OAB-related quality of life. This brings to light that perhaps urologists need to address FI in order to appropriately address OAB and improve their patients’ quality of life. Because it is a difficult topic to bring up, and patients are hesitant to talk about it, clinicians should specifically ask patients about the presence of FI during their evaluations. Future studies should address the specific impact of urologists’ management of FI on OAB treatment outcomes.

Presented by: Caitlin Lim, DO; Vanderbilt University Medical Center

Written by: Dena Moskowitz, MD; Fellow, Female Pelvic Medicine and Reconstructive Surgery, Virginia Mason Medical Center, Twitter: @demoskowitz, at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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