Validation of Risk Factors for Fecal Incontinence in Patients With Crohn’s Disease

BACKGROUND: Fecal incontinence has a great impact on daily life, and many patients are reluctant to report it. OBJECTIVE: The purpose of this study was to estimate the prevalence of fecal incontinence in patients with Crohn's disease, validate risk factors, and relate outcome with quality of life. DESIGN: The design was cross-sectional. SETTINGS: The study was conducted at an academic tertiary center. PATIENTS: Consecutive patients with Crohn's disease treated between 2003 and 2013 were included in this study. MAIN OUTCOME MEASURES: A questionnaire was sent out in October 2013 to evaluate perianal disease, current symptoms of fecal incontinence, and its impact on quality of life (Fecal Incontinence Quality of Life questionnaire). Risk factors were validated with univariate and multivariate analyses. RESULTS: The questionnaire was responded by 325 (62%) of 528 patients. Median age was 42 years (range, 18-91 y), 215 (66%) were women, and a diagnosis of Crohn's disease was established for a median period of 12 years (interquartile range, 6-21 y). Fecal incontinence was reported by 65 patients (20%). Fecal incontinence was associated with liquid stools (p = 0.0001), previous IBD-related bowel resections (p = 0.001), stricturing behavior of disease (p = 0.02), and perianal disease (p = 0.03). Quality of life (lifestyle, coping, depression, and embarrassment) was poor in patients with fecal incontinence, particularly in patients with more frequent episodes of incontinence. LIMITATIONS: There was no correction for disease activity in the multivariate regression analysis. CONCLUSIONS: The prevalence of fecal incontinence in a tertiary population with Crohn's disease is substantially higher than in the community-dwelling population. Considering the reduced quality of life in incontinent patients, active questioning to identify fecal incontinence is recommended in those with liquid stools, perianal disease, or previous (intestinal or perianal) surgery. See Video Abstract at http://journals.lww.com/dcrjournal/Pages/videogallery.aspx.