Simrén M, Palsson O S, Heymen S, Bajor A, Törnblom H, Whitehead W E
Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Neurogastroenterol Motil. 2017 Feb;29(2). doi: 10.1111/nmo.12919. Epub 2016 Aug 31.
Fecal incontinence (FI) is a prevalent but poorly recognized problem in the general population with profound negative effects on daily life. The prevalence of FI in irritable bowel syndrome (IBS) and its association with clinical, demographic, and pathophysiological factors remain largely unknown.
One US (n=304) and one Swedish (n=168) patient cohort fulfilling Rome III criteria for IBS completed Rome III diagnostic questions on FI and IBS symptoms, and questionnaires on IBS symptom severity, quality of life, anxiety and depression, and work productivity impairment. The patients also underwent assessments of colorectal sensitivity and motility.
Fecal incontinence ≥ one day per month was reported by 19.7% (USA) and 13.7% (Sweden) of IBS patients. These proportions rose to 43.4% and 29.8% if patients with less frequent FI were included. Fecal incontinence prevalence was higher in older age groups, with a clear increase above age 40. Irritable bowel syndrome patients with FI reported greater overall IBS symptom severity, more frequent and loose stools, and greater urgency. Negative effects of FI on quality of life, psychological distress, and work productivity were demonstrated. No associations were found between colorectal physiology and FI.
CONCLUSIONS & INFERENCES: Fecal incontinence is common in IBS patients, and similar to previous general population reports, the major risk factors for FI in IBS are older age, rectal urgency, and loose, frequent stools. When IBS patients have comorbid FI, the impact on quality of life, psychological symptoms, and work impairment appears greater.
大便失禁（FI）在普通人群中普遍存在，但却未得到充分认识，对日常生活有严重负面影响。肠易激综合征（IBS）中FI的患病率及其与临床、人口统计学和病理生理因素的关联在很大程度上仍不清楚。
两个符合罗马III标准的IBS患者队列，一个来自美国（n = 304），一个来自瑞典（n = 168），完成了关于FI和IBS症状的罗马III诊断问题，以及关于IBS症状严重程度、生活质量、焦虑和抑郁以及工作效率受损的问卷。患者还接受了结肠直肠敏感性和动力的评估。
IBS患者中，每月至少有一天大便失禁的比例在美国为19.7%，在瑞典为13.7%。如果将大便失禁频率较低的患者包括在内，这些比例分别上升至43.4%和29.8%。老年组大便失禁患病率更高，40岁以上明显增加。有FI的IBS患者报告IBS总体症状更严重，大便更频繁且稀溏，便意更强烈。FI对生活质量、心理困扰及工作效率的负面影响得到证实。未发现结肠直肠生理与FI之间存在关联。
大便失禁在IBS患者中很常见，与之前普通人群的报告相似，IBS中FI的主要危险因素是年龄较大、直肠紧迫感以及稀溏、频繁的大便。当IBS患者合并FI时，对生活质量、心理症状和工作损害的影响似乎更大。
