Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment
Background: In contrast to paediatric and geriatric populations, faecal incontinence and constipation in adults are generally considered separate entities. This may be incorrect. Methods: Cross-sectional study of consecutive patients (18–80 years) referred to a tertiary unit (2004–2016) for investig...
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doaj-3f59b0f3b93b40cc83048f5935fc29592020-11-25T04:04:01ZengElsevierEClinicalMedicine2589-53702020-10-0127100572Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessmentPaul F. Vollebregt0Lukasz Wiklendt1Phil G Dinning2Charles H. Knowles3S.Mark Scott4National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United KingdomCollege of Medicine and Public Health, Flinders University, AustraliaCollege of Medicine and Public Health, Flinders University, Australia; Department of Gastroenterology, Flinders Medical Centre, AustraliaNational Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United KingdomNational Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom; Corresponding author.Background: In contrast to paediatric and geriatric populations, faecal incontinence and constipation in adults are generally considered separate entities. This may be incorrect. Methods: Cross-sectional study of consecutive patients (18–80 years) referred to a tertiary unit (2004–2016) for investigation of refractory faecal incontinence and/or constipation and meeting Rome IV core criteria (applied post-hoc) for self-reported symptoms. We sought to determine how frequently both diagnoses coexisted, how frequently coexistent diagnoses were recognised by the referring clinician and to evaluate differences in clinical characteristics between patients with single or both diagnoses. Findings: Study sample consisted of 4,027 patients (3,370 females [83·7%]). According to Rome IV criteria, 807 (20·0%) patients self-reported faecal incontinence in isolation, 1,569 (39·0%) patients had functional constipation in isolation, and 1,651 (41·0%) met criteria for both diagnoses (coexistent symptoms). In contrast, only 331 (8·2%) patients were referred for coexistent symptoms. Of the 1,651 patients with self-reported coexistent symptoms, only 225 (13·6%) were recognised by the referrer i.e. 86·4% were missed. Coexistent symptoms were most often missed in patients referred for faecal incontinence in isolation. In this group of 1,640 patients, 765 (46·7%) had concomitant symptoms of functional constipation. Opioid usage, comorbidities, childhood bowel problems, mixed incontinence symptoms, prolapse symptoms and structural abnormalities on defaecography were associated with reclassification. Interpretation: Over 40% of adults referred for anorectal physiological investigation had coexistent diagnoses of faecal incontinence and functional constipation, based on validated criteria. This overlap is overlooked by referrers, poorly documented in current literature, and may impact management.http://www.sciencedirect.com/science/article/pii/S2589537020303163Anorectal physiologyConstipationFaecal incontinencePelvic floor dysfunction |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Paul F. Vollebregt Lukasz Wiklendt Phil G Dinning Charles H. Knowles S.Mark Scott |
spellingShingle |
Paul F. Vollebregt Lukasz Wiklendt Phil G Dinning Charles H. Knowles S.Mark Scott Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment EClinicalMedicine Anorectal physiology Constipation Faecal incontinence Pelvic floor dysfunction |
author_facet |
Paul F. Vollebregt Lukasz Wiklendt Phil G Dinning Charles H. Knowles S.Mark Scott |
author_sort |
Paul F. Vollebregt |
title |
Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment |
title_short |
Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment |
title_full |
Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment |
title_fullStr |
Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment |
title_full_unstemmed |
Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment |
title_sort |
coexistent faecal incontinence and constipation: a cross-sectional study of 4027 adults undergoing specialist assessment |
publisher |
Elsevier |
series |
EClinicalMedicine |
issn |
2589-5370 |
publishDate |
2020-10-01 |
description |
Background: In contrast to paediatric and geriatric populations, faecal incontinence and constipation in adults are generally considered separate entities. This may be incorrect. Methods: Cross-sectional study of consecutive patients (18–80 years) referred to a tertiary unit (2004–2016) for investigation of refractory faecal incontinence and/or constipation and meeting Rome IV core criteria (applied post-hoc) for self-reported symptoms. We sought to determine how frequently both diagnoses coexisted, how frequently coexistent diagnoses were recognised by the referring clinician and to evaluate differences in clinical characteristics between patients with single or both diagnoses. Findings: Study sample consisted of 4,027 patients (3,370 females [83·7%]). According to Rome IV criteria, 807 (20·0%) patients self-reported faecal incontinence in isolation, 1,569 (39·0%) patients had functional constipation in isolation, and 1,651 (41·0%) met criteria for both diagnoses (coexistent symptoms). In contrast, only 331 (8·2%) patients were referred for coexistent symptoms. Of the 1,651 patients with self-reported coexistent symptoms, only 225 (13·6%) were recognised by the referrer i.e. 86·4% were missed. Coexistent symptoms were most often missed in patients referred for faecal incontinence in isolation. In this group of 1,640 patients, 765 (46·7%) had concomitant symptoms of functional constipation. Opioid usage, comorbidities, childhood bowel problems, mixed incontinence symptoms, prolapse symptoms and structural abnormalities on defaecography were associated with reclassification. Interpretation: Over 40% of adults referred for anorectal physiological investigation had coexistent diagnoses of faecal incontinence and functional constipation, based on validated criteria. This overlap is overlooked by referrers, poorly documented in current literature, and may impact management. |
topic |
Anorectal physiology Constipation Faecal incontinence Pelvic floor dysfunction |
url |
http://www.sciencedirect.com/science/article/pii/S2589537020303163 |
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