Effect of darifenacin on fecal incontinence in women with double incontinence

• Published in: International Urogynecology Journal Vol. 32; no. 9; pp. 2357 - 2363
• Main Authors: Kissane, Lindsay M., Martin, Kimberly D., Meyer, Isuzu, Richter, Holly E.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2021; Springer Nature B.V
• Subjects: Aged; Benzofurans; Bladder; Cohort Studies; Fecal incontinence; Fecal Incontinence - drug therapy; Feces; Female; Gynecology; Humans; Medicine; Medicine & Public Health; Middle Aged; Original Article; Prospective Studies; Pyrrolidines; Quality of Life; Treatment Outcome; Urinary Bladder, Overactive - complications; Urinary Bladder, Overactive - drug therapy; Urinary Incontinence; Urinary Incontinence, Urge; Urology; Fecal incontinence; Accidental bowel leakage; Overactive bladder; Dual incontinence; Urge urinary incontinence; Double incontinence
• ISSN: 0937-3462; 1433-3023; 1433-3023
• DOI: 10.1007/s00192-020-04369-3

Introduction and hypothesis To evaluate change in fecal incontinence symptom severity after 8 weeks of darifenacin therapy in patients with double incontinence-urgency urinary incontinence (UUI) and fecal incontinence. Important secondary outcomes included fecal incontinence symptom distress and impact on quality of life, fecal incontinence episodes, global impression of improvement and overactive bladder symptom distress and impact. Methods Prospective open-label cohort study of women presenting primarily with UUI, diagnosed with double incontinence and electing antimuscarinic therapy for UUI. Women ≥ 18 years with moderate or greater bothersome UUI and fecal incontinence of liquid/solid stool with St. Marks (Vaizey) score ≥ 12 were included. Subjects were treated with darifenacin 15 mg daily for 8 weeks. The primary outcome was change in fecal incontinence symptom severity using the St. Marks (Vaizey) score after 8 weeks. Sample size was based on the minimally important difference of the St. Marks, −5, and standard deviation, ± 8.5; 30 subjects provided 80% power and type I error of 0.05, including a 15% attrition rate. Results Thirty-two women were consented with mean baseline St. Marks (Vaizey) score of 18.0 ± 3.0. Mean age was 66.5 ± 10.3 years. Twenty-eight subjects (29/32, 87.5%) completed assessments. St. Marks (Vaizey) score significantly improved from 18.0 to 11.0 [mean difference − 7.0, 95% confidence interval (CI): −8.7, −5.3], and 19 subjects (19/32,67.9%) met the minimally important difference. Statistically significant improvements were also noted in fecal incontinence frequency, quality of life, and overactive bladder symptom bother and quality of life (all p  < 0.01). Conclusions Darifenacin can be considered a highly effective early intervention in women suffering from double incontinence. Clinical trial registration Bladder Antimuscarinic Medication and Accidental Bowel Leakage (BAMA), https://clinicaltrials.gov/ct2/show/NCT03543566 , NCT03543566.