United European Gastroenterol J. 2024 Sep 8. doi: 10.1002/ueg2.12657. Online ahead of print.

Nadia Wespi ¹, Stephan Vavricka ¹, Stephan Brand ², Patrick Aepli ³, Emanuel Burri ⁴, Benjamin Misselwitz ⁵, Frank Seibold ⁶, Petr Hruz ⁷, Laurent Peyrin-Biroulet ^8 9 10, Alain Schoepfer ¹¹, Luc Biedermann ¹, Christiane Sokollik ¹², Gerhard Rogler ¹, Thomas Greuter ^1 11 13

Author information

¹Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.

²Division of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

³Division of Gastroenterology and Hepatology, Cantonal Hospital Lucerne, Lucerne, Switzerland.

⁴Division of Gastroenterology and Hepatology, University Medical Clinic, Cantonal Hospital Baselland, Liestal, Switzerland.

⁵Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.

⁶Intesto Crohn and Colitis Center, Bern, Switzerland.

⁷Division of Gastroenterology and Hepatology, Clarunis, University Hospital Basel, Basel, Switzerland.

⁸Department of Gastroenterology, INFINY Institute, FHU-CURE, INSERM NGERE, Nancy University Hospital, Vandœuvre-lès-Nancy, France.

⁹Groupe Hospitalier privé Ambroise Paré - Hartmann, Paris IBD Center, Neuilly-sur-Seine, France.

¹⁰Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.

¹¹Division of Gastroenterology and Hepatology, CHUV University Hospital Lausanne and University of Lausanne UNIL, Lausanne, Switzerland.

¹²Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital, Bern University Hospital, University of Bern, Bern, Switzerland.

¹³Division of Gastroenterology and Hepatology, GZO-Zurich Regional Health Center, Wetzikon, Switzerland.

Abstract

Introduction: Although increasingly appreciated, little is known about the prevalence of fecal urgency, fecal incontinence and differences between patients' and physicians' perception in inflammatory bowel disease (IBD).

Methods: We performed an online patient and physician survey to evaluate the assessment, prevalence and impact of fecal urgency and incontinence in IBD.

Results: A total of 593 patients (44.0% ulcerative colitis (UC), 53.5% Crohn's disease (CD), 2.2% indeterminate colitis, 2 not specified) completed the survey (65.8% females, mean age 47.1 years). Fecal urgency was often reported (UC: 98.5%, CD: 96.2%) and was prevalent even during remission (UC: 65.9%, CD: 68.5%). Fecal urgency considerably impacted daily activities (visual analog scale [VAS] 5, IQR 3-8). Yet, 22.8% of patients have never discussed fecal urgency with their physicians. Fecal incontinence was experienced by 44.7% of patients and 7.9% on a weekly basis. Diapers/pads were required at least once a month in 20.4% of patients. However, 29.7% of patients never talked with their physician about fecal incontinence. UC was an independent predictor for the presence of moderate-severe fecal urgency (OR 1.65, 95% CI 1.13-2.41) and fecal incontinence (OR 1.77, 95% CI 1.22-2.59). All physicians claimed to regularly inquire about fecal urgency and incontinence. However, the impact of these symptoms on daily activities was overestimated compared with the patient feedback (median VAS 8 vs. 5, p = 0.0113, and 9 vs. 5, p = 0.0187).

Conclusions: Fecal urgency and incontinence are burdensome symptoms in IBD, with a similar prevalence in UC and CD. A mismatch was found between the physician and patient perception. These symptoms should be addressed during outpatient visits.