Fecal incontinence (FI) and chronic constipation (CC) both occurring concurrently, prevalent in both men and women equally, has over the years been very poorly researched and need a newer management approach to its treatment, Satish Rao, MD, explained during a presentation at the Digestive Disease Week (DDW) 2023 in Chicago.

Dr Rao is a professor of medicine and a gastroenterologist at Augusta University in Augusta, Georgia.

FI and CC in adults are generally considered to be separate entities, separate problems,” Dr Rao said during the anorectal dysmotility session. “This may be grossly incorrect.” A retrospective survey of patients from a tertiary care center revealed that while there were 31 healthy controls, and 144 patients with FI alone; there were 165 patients who presented symptoms of both FI and CC.

However, since this overlapping syndrome has been poorly characterized and underrecognized, data on the clinical patterns and pathophysiological features of patients are lacking, Dr Rao said.

Of the 165 patients identified with the overlapping symptoms, it was important to note that the number of men and women were similar, Dr Rao remarked. However, the prevalence of excessive straining, incomplete bowel movement, abdominal pain, bloating, digital maneuvers and enema use were significantly higher in the patient group with the overlapping conditions as compared to those with just FI alone. On the other hand, the resting, squeeze, and sustained squeeze pressure were significantly lower in the overlap group and FI group compared to healthy controls.

Owing to the lack of patterns, Dr Rao insisted on pooling resources to identify and distinguish patients suffering from an overlap of both FI and CC. “Management approaches for the overlap group may differ and could include management of constipation and dyssynergic defecation together with the treatment of FI,” he concluded.

—Priyam Vora

Reference:
Rao S. Presentation #Tu1683: Clinical characteristics and pathophysiology of overlapping fecal incontinence and constipation: An underrecognized problem. Digestive Disease Week 2023. Chicago, Illinois.