Bowel habits and fecal incontinence in patients with obesity undergoing evaluation for weight loss: the importance of stool consistency

David Parés, Helena Vallverdú, Gabriela Monroy, Pilar Amigo, Cristina Romagosa, Miquel Toral, Judit Hermoso, Gerardo Saenz-de-Navarrete
Diseases of the Colon and Rectum 2012, 55 (5): 599-604

BACKGROUND: Fecal incontinence is highly prevalent in the general population and especially in risk groups. Obesity is also common and is associated with comorbidities that impair general health and interfere with daily activities. Identifying mutable factors for fecal incontinence, such as stool consistency, is of paramount importance to improve quality of life.

OBJECTIVE: The aim of this study was to estimate the prevalence of fecal incontinence in patients with obesity undergoing evaluation for weight loss, its relationship with bowel habits, and its impact on quality of life.

DESIGN: This investigation is a cross-sectional observational study.

SETTINGS: This study was conducted in patients with obesity who were undergoing evaluation for weight loss.

MAIN OUTCOME MEASURES: Fecal incontinence was defined as loss of flatus or liquid/solid stool occurring at least monthly. Data on comorbidities, BMI, quality of life, bowel habits including stool consistency measured with the Bristol Stool Form Scale, and symptoms of fecal incontinence were collected.

RESULTS: Fifty-two patients were included, with a mean BMI of 39.6 kg/m2. Symptoms of fecal incontinence were found in 17 patients (32.7%): flatus in 9 of 17 (52.9%), liquid stool in 6 of 17 (35.2%), and solid stool in 2 of 17 (11.7%). No differences were found between patients with and without fecal incontinence in age, sex, comorbidities, or BMI. Health-related quality of life was lower in patients with fecal incontinence than in those without, but this difference was not significant, with the exception of the dimensions of role-physical (p = 0.03) and social functioning (p = 0.04). Patients with incontinence reported significantly higher percentages of altered bowel habits with nonformed stools (p = 0.004).

LIMITATIONS: The cross-sectional design hampered identification of the time at which the impact of obesity occurred.

CONCLUSIONS: Fecal incontinence is common in patients with obesity. Stool consistency was significantly different in these patients. This study supports the possibility of improving incontinence during weight loss by modifying stool consistency.


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