The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

• Published in: Alimentary pharmacology & therapeutics Vol. 58; no. 1; pp. 26 - 34
• Main Authors: Vasant, Dipesh H., Nigam, Gaurav B., Bate, Sebastian, Hamdy, Shaheen, Limdi, Jimmy K.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.07.2023
• Subjects: Anxiety; Colitis, Ulcerative - epidemiology; Cross-Sectional Studies; disorders of gut‐brain interaction; faecal incontinence; Fecal Incontinence; Humans; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - complications; Mental depression; Prevalence; Prospective Studies; Quality of Life; Remission; Remission (Medicine); Rome; Severity of Illness Index; Ulcerative colitis; Rome; ulcerative colitis; faecal incontinence; inflammatory bowel disease; disorders of gut-brain interaction
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.17502

Summary Background Despite advances in ulcerative colitis (UC) therapies, a relatively undefined proportion of patients experience faecal incontinence (FI) in the absence of active inflammation. For this group, there remains a significant unmet need with a limited evidence base. Aims We aimed to estimate the prevalence and impact of FI in UC. Methods In a prospective cross‐sectional study, patients with UC completed a series of validated questionnaires, including Rome IV FI criteria, an inflammatory bowel disease (IBD)‐specific FI questionnaire (ICIQ‐IBD), Hospital Anxiety and Depression Scale and IBD‐Control. UC remission was defined as faecal calprotectin (FCP) ≤250 μg/g, or IBD‐control 8 score ≥13 and IBD‐Control‐VAS ≥ 85. Results Of 255 patients with UC, overall, 20.4% fulfilled Rome IV criteria for FI. Rome IV FI prevalence did not differ between active and quiescent UC regardless of whether disease activity was defined by IBD‐Control scores ± FCP (p = 0.25), or objectively with FCP thresholds of 250 μg/g (p = 0.86) and 100 μg/g (p = 0.95). Most patients (75.2%) reported FI when in ‘remission’ and during ‘relapse’ (90.6%) according to ICIQ‐IBD. Those who reported FI according to both ICIQ‐IBD and Rome IV definitions had higher anxiety, depression and worse quality‐of‐life (QoL) scores (p < 0.05). In those with Rome IV FI, there was a strong correlation between FI symptom severity and impaired QoL (r = 0.809, p < 0.001). Conclusions The prevalence of FI in UC is high, even in remission, and associated with significant psychological distress, symptom burden and impaired QoL. These findings highlight the urgent need for further research and development of evidence‐based treatments for FI in UC. The prevalence of Rome IV Faecal Incontinence (FI) of 20.4% in ulcerative colitis (UC) is much higher than in the general population. The prevalence of FI is similar in active and quiescent UC and is associated with impaired quality of life and psychological distress.