Am J Obstet Gynecol. 2022 Dec 9;S0002-9378(22)02267-0. doi: 10.1016/j.ajog.2022.12.007.Online ahead of print.

Chihiro Okada ¹, Joseph I Kim ¹, Michal L Melamed ², Nitya Abraham ³, Priyanka Kadam Halani ⁴

Author information

¹Albert Einstein College of Medicine.

²Division of Nephrology, Department of Medicine, Montefiore Medical Center, Bronx, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.

³Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.

⁴Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY. Electronic address: pkadamhalani@gmail.com.

Abstract

Background: Fecal incontinence is a prevalent debilitating pelvic floor disorder characterized by the involuntary loss of stool. Fecal incontinence is known to be associated with constipation and loose stool, advancing age, chronic comorbidities, and prior anorectal trauma, among other biologic risk factors. The relationship between social determinants of health, such as food insecurity, and fecal incontinence is not well-elucidated.

Objective: We aimed to investigate the association between fecal incontinence and food insecurity using a nationally representative sample of US adult women. Our secondary aim was to examine the role of diet by assessing dietary differences between participants with versus without fecal incontinence and between food insecure women with and without fecal incontinence.

Study design: We analyzed data from the National Health and Nutrition Examination Survey, a nationally representative series of cross-sectional health surveys. Fecal incontinence was defined as accidental leakage of stool within the last 30 days. Food insecurity was assessed using the household food security measure created by the US Department of Agriculture. Dietary data from NHANES dietary interviews titled "Individual Foods, First Day" and "Individual Foods, Second Day," which estimates the foods and drinks consumed in the preceding 24 hours, were pooled. The association between fecal incontinence and food insecurity was analyzed using logistic regression after controlling for patient characteristics.

Results: A total of 3,216 women were included, representing nearly 130 million US women. Of these, 10.9% had fecal incontinence. There were no significant differences in diet between women with and without fecal incontinence. Food insecure women in the overall sample reported higher carbohydrate and sugar intake and lower fiber and alcohol intake (all p<0.05). Amongst food insecure women, those with fecal incontinence had higher calorie and total fats intake than those without fecal incontinence; there were no significant differences in other dietary components. There was a significant association between food insecurity and fecal incontinence, such that women with food insecurity had higher odds of fecal incontinence after adjusting for patient characteristics and diet (OR 1.76; 95% CI=1.17-2.66; p=0.008).

Conclusion: Food insecurity is associated with fecal incontinence even after accounting for diet. Understanding the role of social determinants of health in fecal incontinence symptomatology and treatment is important to potentially alleviate symptom burden and improve quality of life in at-risk populations.