The Prevalence and Impact of Dyssynergic Defecation in Patients Who Solely Report Fecal Incontinence

Menees SB^1,2,*, Baker JR¹, Jackson K¹, Chey WD¹

¹Department of Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI

²Department of Division of Gastroenterology, Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI

*Corresponding Author: Stacy B. Menees, Department of Division of Gastroenterology, Department of Internal Medicine, 3912 Taubman Center, SPC 5362 Ann Arbor, MI 48109-5362 Tele: 734-936-4775 E-mail: sbartnik@umich.edu

Citation: Menees SB (2020) The Prevalence and Impact of Dyssynergic Defecation in Patients Who Solely Report Fecal Incontinence. World J Gastroenterol Hepatol Endosc. 3(3); 1-4

Copyright: ©2020 Menees SB, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.

ABSTRACT

Background/Aims: Dyssynergic Defecation (DD) has been associated with fecal soiling but has not been studied in patients with fecal incontinence (FI). The aim is to measure the prevalence of DD in FI patients undergoing High Resolution ARM (HRARM).

Methods: A retrospective analysis of patients with FI who underwent HRARM at a tertiary care center (May 2015-November 2017) was performed. DD was defined as an abnormal sphincter response during simulated defecation and an abnormal BET. At the time of HRARM, patients completed two validated surveys: Fecal Incontinence Severity Index (FISI) and the Fecal Incontinence Quality of Life Instrument FIQL. Bivariate analyses with student’s t test and Pearson’s chi square test were performed to assess the association between DD and ARM findings/FISI/FIQL.

Key Results: 336 subjects with FI had undergone HRARM. 14.5% with FI were found to have DD (FI-DD). 52.3% were noted to have a paradoxical sphincter contraction on HRARM. 30.4% of the FI cohort were found to have an abnormal BET. Of those patients found to have DD by both criteria, the DD types found were type 1-61.2%, type 3-32.7% and type 4-6.1%. There were no significant demographic, HRARM findings, symptom severity or QOL differences between patient with FI-DD and FI.

Conclusions: 1 in 7 FI patients have DD and almost a third have an abnormal BET. Symptom severity and QOL was similar between FI patients with and without DD. Further research to determine whether physical therapy and biofeedback directed at DD improves FI is warranted.

KEYWORDS: Fecal incontinence, Dyssynergic defecation, Accidental bowel loss

ABBREVIATIONS: FI: Fecal Incontinence; DM: Diabetes Mellitus; GI: Gastrointestinal; IBS: Irritable Bowel Syndrome; NIH: National Institutes of Health; PROMIS: Patient Reported Outcomes Measurement Information System

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