Characterization of symptom severity and impact on four fecal incontinence phenotypes in women presenting for evaluation

Neurourol Urodyn. 2020 Oct 20. doi: 10.1002/nau.24541. Online ahead of print.

Tanya P Hoke 1, Isuzu Meyer 1, Christina T Blanchard 2, Jeff M Szychowski 2 3, Holly E Richter 1


Author information

  • 1Division of Urogynecology and Pelvic Reconstructive Surgery, Department Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • 2Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • 3Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA.


Aim: To characterize symptom-specific distress and impact on quality of life (QOL) among women with urge, passive, and combined urge/passive fecal incontinence (FI) phenotypes. A secondary aim was to characterize FI symptom-specific distress and impact on women with a novel fourth phenotype, stress FI.

Methods: Women with at least monthly FI from 2003 to 2017 were included. Participants completed the Modified Manchester Health Questionnaire (MMHQ) including MHQ and Fecal Incontinence Severity Index (FISI). Anorectal manometry (ARM) and endoanal ultrasound (EAUS) testing was performed. Total MHQ and FISI scores were compared across FI subtypes controlling for pertinent baseline covariates.

Results: The cohort included 404 subjects, 220 meeting criteria for urge FI, 67 passive FI, and 117 combined urge/passive FI. On MHQ, women with combined urge/passive FI were most impacted (p < 0.01). FISI scores were significantly different from combined urge/passive FI having the greatest impact (38.1 ± 12.5) and urge FI (31.1 ± 11.3), p < 0.01 having the least. No differences were observed in ARM measurements or anal sphincter defects among the three groups (all p > 0.05). Twenty-nine subjects were identified with stress FI. There were no differences in overall MHQ or FISI scores or anal sphincter evaluation among the urge, passive, and stress FI groups (all p > 0.05).

Conclusion: Women with combined urge/passive FI have higher symptom distress and impact on QOL than urge or passive FI alone. Further research is needed to determine the significance of stress FI as a subtype and response to treatment.

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