Center for Functional Gastrointestinal and Motility Disorders, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Center for Functional Gastrointestinal and Motility Disorders, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Clin Gastroenterol Hepatol. 2020 Feb;18(2):385-391. doi: 10.1016/j.cgh.2019.05.040. Epub 2019 May 30.
BACKGROUND & AIMS: The diagnostic criteria for fecal incontinence (FI) were made more restrictive in the Rome IV revision. We aimed to determine the characteristics of FI patients defined by the Rome IV criteria, assess how FI frequency and amount affect quality of life, identify risk factors, and compare prevalence values among countries.
We performed an internet-based survey of 5931 subjects in the United States, Canada, and the United Kingdom, from September to December 2015. Subjects were stratified by country, sex, and age. Responders answered questions about diagnosis, health care use, and risk factors. We performed multivariate linear regression analysis to identify risk factors for FI.
FI was reported by 957 subjects (16.1%) but only 196 (3.3%) fulfilled the Rome IV criteria. Frequency of FI was less than twice a month for 672/957 subjects (70.2%) and duration was less than 6 months for 285/957 subjects (29.8%). Quality of life was significantly impaired in all subjects with FI compared to subjects with fecal continence. The strongest risk factors for FI were diarrhea, urgency to defecate, and abdominal pain. FI was more prevalent in the United States than in the United Kingdom. Between-country differences were due to less diarrhea and urgency in the United Kingdom.
Rome IV FI prevalence is lower than previous estimates because the new criteria exclude many individuals with less frequent or short duration FI. These excluded patients have impaired quality of life. It might be appropriate to make a diagnosis of FI for all patients with FI ≥2 times in 3 months and to provide additional information on frequency, duration, and amount of stool lost to assist clinicians in treatment selection.
罗马 IV 修订版对粪便失禁 (FI) 的诊断标准更加严格。我们旨在确定符合罗马 IV 标准的 FI 患者的特征，评估 FI 频率和量如何影响生活质量，确定危险因素，并比较各国的患病率。
我们于 2015 年 9 月至 12 月对美国、加拿大和英国的 5931 名受试者进行了一项基于互联网的调查。受试者按国家、性别和年龄分层。应答者回答了关于诊断、医疗保健使用和危险因素的问题。我们进行了多变量线性回归分析，以确定 FI 的危险因素。
957 名受试者（16.1%）报告有 FI，但只有 196 名（3.3%）符合罗马 IV 标准。957 名 FI 受试者中，672 名（70.2%）FI 频率低于每月两次，285 名（29.8%）FI 持续时间少于 6 个月。与具有正常排便功能的受试者相比，所有有 FI 的受试者的生活质量均显著受损。FI 的最强危险因素是腹泻、排便急迫和腹痛。与英国相比，FI 在美国更为普遍。国家间的差异是由于英国腹泻和急迫性较低。
罗马 IV FI 的患病率低于以往的估计，因为新的标准排除了许多 FI 频率较低或持续时间较短的患者。这些被排除的患者生活质量受损。对于所有 3 个月内 FI 发作≥2 次的患者，可能适合做出 FI 诊断，并提供有关频率、持续时间和丢失粪便量的更多信息，以帮助临床医生选择治疗方案。
