Bliss Donna Z, Savik Kay, Jung Hans-Joachim G, Whitebird Robin, Lowry Ann, Sheng Xiaoyan
School of Nursing, University of Minnesota, 5-140 Weaver-Densford Hall, 308 Harvard St. SE, Minneapolis, MN, 5545.
Res Nurs Health. 2014 Oct;37(5):367-78. doi: 10.1002/nur.21616. Epub 2014 Aug 23.
Dietary fiber supplements are used to manage fecal incontinence (FI), but little is known about the fiber type to recommend or the level of effectiveness of such supplements, which appears related to the fermentability of the fiber. The aim of this single-blind, randomized controlled trial was to compare the effects of three dietary fiber supplements (carboxymethylcellulose [CMC], gum arabic [GA], or psyllium) with differing levels of fermentability to a placebo in community-living individuals incontinent of loose/liquid feces. The primary outcome was FI frequency; secondary outcomes included FI amount and consistency, supplement intolerance, and quality of life (QoL). Possible mechanisms underlying supplement effects were also examined. After a 14-day baseline, 189 subjects consumed a placebo or 16 g total fiber/day of one of the fiber supplements for 32 days. FI frequency significantly decreased after psyllium supplementation versus placebo, in both intent-to-treat and per-protocol mixed model analyses. CMC increased FI frequency. In intent-to-treat analysis, the number of FI episodes/week after supplementation was estimated to be 5.5 for Placebo, 2.5 for Psyllium, 4.3 for GA, and 6.2 for CMC. Only psyllium consumption resulted in a gel in feces. Supplement intolerance was low. QoL scores did not differ among groups. Patients with FI may experience a reduction in FI frequency after psyllium supplementation, and decreased FI frequency has been shown to be an important personal goal of treatment for patients with FI. Formation of a gel in feces appears to be a mechanism by which residual psyllium improved FI.
膳食纤维补充剂被用于治疗大便失禁（FI），但对于推荐何种纤维类型或此类补充剂的有效性水平却知之甚少，而这似乎与纤维的可发酵性有关。这项单盲随机对照试验的目的是比较三种可发酵性不同的膳食纤维补充剂（羧甲基纤维素[CMC]、阿拉伯胶[GA]或车前子）与安慰剂对社区中大便松散/呈液态失禁个体的影响。主要结局是FI发作频率；次要结局包括FI的量和大便稠度、补充剂不耐受情况以及生活质量（QoL）。还研究了补充剂作用的潜在机制。在14天的基线期后，189名受试者服用安慰剂或每天总共16克的一种纤维补充剂，为期32天。在意向性分析和符合方案的混合模型分析中，与安慰剂相比，补充车前子后FI发作频率显著降低。CMC增加了FI发作频率。在意向性分析中，补充后每周的FI发作次数估计为：安慰剂组5.5次，车前子组2.5次，GA组4.3次，CMC组6.2次。只有服用车前子会使粪便中形成凝胶。补充剂不耐受情况较少。各组间QoL评分无差异。FI患者补充车前子后FI发作频率可能会降低，而且已表明降低FI发作频率是FI患者重要的个人治疗目标。粪便中形成凝胶似乎是残留车前子改善FI的一种机制。
