Fecal incontinence and constipation more prevalent among Obese patients

Obesity has become a worldwide problem, being recognized as a "global epidemic" by the WHO in 1997. The recent studies have identified obesity as an independent risk factor for pelvic floor disorders, including urinary (UI) and fecal incontinence (FI); both of which are complex and under-diagnosed problems with physiologically and socially devastating consequences.

The American Journal of Gastroentrology from a cross sectional study reveals that obesity significantly impacts specific defecatory mainly fecal incontinence and prolapse symptoms and pathophysiologic findings.

The Cross-sectional study of consecutive patients meeting Rome IV criteria for FI and/or functional constipation, with data on body mass index (BMI), attending a tertiary center for investigation between 2017-2021. Clinical history, symptoms and anorectal physiologic test results were analyzed according to BMI categories.

The study found that

• A total of 1,155 patients (84% female) were included in the analysis (33.5% normal BMI; 34.8% overweight; 31.7% obese).

• Obese patients had higher odds of FI to liquid stools (69.9 vs. 47.8%, OR 1.96 [CI: 1.43-2.70]), use of containment products (54.6% vs. 32.6%, OR 1.81 [1.31-2.51]), fecal urgency (74.6% vs. 60.7%, OR 1.54 [1.11-2.14]) urge FI (63.4% vs 47.3%, OR 1.68 [1.23-2.29]), and vaginal digitation (18.0% vs 9.7%, OR 2.18 [1.26-3.86]).

• Higher proportions of obese patients had Rome criteria-based FI or coexistent FI and functional constipation (37.3%, 50.3%) compared with overweight (33.8%, 44.8%) and normal BMI patients (28.9%, 41.1%).

• There was a positive linear association between BMI and anal resting pressure (β 0.45, R2 0.25, p=0.0003), though the odds of anal hypertension were not significantly higher after Benjamini-Hochberg correction.

• Obese patients more often had a large clinically significant rectocele (34.4% vs. 20.6%, OR 2.62 [1.51-4.55]) compared with normal BMI patients.

Researchers concluded that “Obesity impacts specific defecatory (mainly FI) and prolapse symptoms and pathophysiologic findings (higher anal resting pressure, significant rectocele). Prospective studies are required to determine if obesity is a modifiable risk factor for FI and constipation.”

Reference: Chaichanavichkij, Pam MBChB, MRCS1,a; Vollebregt, Paul F MD, PhD1; Keshishian, Karekin MD, MRCS2; Knowles, Charles H PhD, FRCS1; Scott, S Mark PhD1. The clinical impact of obesity in patients with disorders of defecation: a cross-sectional study of 1,155 patients. The American Journal of Gastroenterology, July 07, 2023. | DOI: 10.14309/ajg.0000000000002400.