TOPLINE

An individualized plan of diet, medications, and pelvic floor exercises was followed by a sustained reduction of at least 75% in incontinence episodes, at both 1 and 3 months, in 15% of adults with moderate-to-severe fecal incontinence (FI). Those with a sustained reduction also reported meaningful quality-of-life gains in most areas measured.

METHODOLOGY

• Guidelines recommend beginning FI management with medical-behavioral therapy (MBT) — diet and lifestyle changes, medications, and pelvic floor exercises — but evidence supporting it has been limited, and no earlier study has tailored it to each patient's underlying bowel problem.
• Researchers conducted an analysis of a clinical trial in which adults with FI who had at least four episodes and completed a 2-week stool diary were initially treated with MBT. They assessed its effects on FI and FI-related quality of life at 1 and 3 months and looked for predictors of response.
• Of 275 adults who were started on MBT, 260 were deemed evaluable at 1 month, and only 1-month responders continued receiving MBT through 3 months. Among the 260 adults considered evaluable, 87% were women, and nearly 25% had previously undergone anorectal procedures, colon resection, or both.
• MBT was delivered using a standard pamphlet and included educational information on bowel function, scheduled toileting, and nurse-taught pelvic floor exercises. Diet and drugs were individualized to each patient's diary pattern; treatment alternatives included supplementation with fiber, antidiarrheals, and laxatives.
• The primary outcome was a reduction of at least 75% in incontinence frequency compared with the baseline.

TAKEAWAY

• At 1 month, 60 adults (23%) achieved at least a 75% reduction in FI frequency, but only 39 (15%) maintained that response at 3 months.
• After 3 months of MBT, sustained responders had far fewer FI episodes per week than nonresponders assessed at 1 or 3 months (7.3 vs 2.4 fewer; P < .001), along with firmer stools (0.6-point vs 0.2-point drop in the Bristol scale score; P = .03) and milder symptoms (2.3-point vs 0.5-point drop in the severity scale; P < .001); only responders' drop in FI episodes met the minimum clinically important difference.
• Sustained responders showed significant improvements in all four areas of FI-related quality of life, covering daily activities, coping, depression, and embarrassment (P < .001), and these gains were significantly greater in responders than in nonresponders (P ≤ .006).
• Among the 60 adults who completed 3 months of MBT, a model including baseline FI frequency, changes in stool consistency, and anal sphincter defects explained 38.9% of the variation in how much FI frequency changed (P = .0002). For the same shift toward firmer stools, patients with more frequent FI at the start had a bigger drop in episodes.

IN PRACTICE

"These approaches are readily implementable in clinical practice but require time both during the initial evaluation and follow-up visits as well as nursing or other allied health support. In our experience, limited clinician time is a major barrier to implementing these measures in routine practice. After initiating MBT, close follow-up, supplemented with daily bowel diaries as needed, is essential to assess treatment response, reinforce adherence, and identify persistent symptoms," the authors wrote.

SOURCE

The study was led by Muhammad Abdul Rehman, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. It was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS

As the study had no placebo group, it could not prove that the treatment caused the improvements. Some symptom improvement may have happened because of other factors such as patients enrolling when their symptoms were at their worst and then improving on their own or symptoms naturally varying over time. The 1-month response rate (23%) was higher than the 13% seen with placebo in an earlier trial; however, as the two studies differed in design and patient populations, they could not be compared directly.

DISCLOSURES

This study was supported by a grant from the National Institutes of Health. One author reported having a patent for the portable manometry device used in this study and receiving royalties from its licensing. Other authors reported having consulting roles, being board members, holding patents, or receiving research funding or royalties from pharmaceutical and device companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.