Lodhia Nayna A, Hiramoto Brent, Horton Laura, Goldin Alison H, Chan Walter W
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Am J Gastroenterol. 2025 Jan 8. doi: 10.14309/ajg.0000000000003308.
Hindgut symptoms are poorly understood complications of obesity. The impact of obesity on fecal incontinence (FI) and anorectal physiology remains unclear, with inconsistent results in prior studies. We aimed to evaluate the relationship between obesity and FI, and the physiological changes in anorectal function.
This was a retrospective cohort study of consecutive adults who underwent high-resolution anorectal manometry (HRAM) at a tertiary center for anorectal symptoms. Demographics, clinical history, surgical/obstetric history, medications, and HRAM findings were reviewed. Patients were classified as nonobese (body mass index [BMI] <25 kg/m 2 ), overweight (BMI 25-29.9 kg/m 2 ), class I obesity (30-34.9 kg/m 2 ), and class II + III obesity (>35 kg/m 2 ). The Fisher exact/Student t test for univariate analyses and logistic/general linear regression for multivariable analyses were performed.
A total of 552 adults were included. The mean BMI was higher among patients with FI (27.5 vs 25.9 kg/m 2 , P = 0.013). Compared with the nonobese group, FI was more prevalent in class II + III obesity (31.7% vs 13.2%, P = 0.0024), but not class I obesity or overweight groups. On multivariable analysis controlling for potential confounders, class II + III obesity (adjusted odds ratio 2.89, 95% confidence interval 1.28-6.50, P = 0.02) remained an independent risk factor of FI. Among patients with FI, both BMI (β-coefficient 1.09, P = 0.016) and class II + III obesity (β-coefficient 18.9, P = 0.027) independently predicted increased first rectal sensation volume on HRAM on multivariable regression.
Classes II + III obesity was an independent risk factor of FI. Among patients with FI, increasing BMI and class II + III obesity were associated with altered rectal sensitivity. Anorectal function testing should be considered to help guide management of FI among patients with obesity.
后肠症状是肥胖症中了解较少的并发症。肥胖对大便失禁（FI）和肛门直肠生理功能的影响仍不明确，先前研究结果不一致。我们旨在评估肥胖与FI之间的关系以及肛门直肠功能的生理变化。
这是一项对在三级中心因肛门直肠症状接受高分辨率肛门直肠测压（HRAM）的连续成年患者进行的回顾性队列研究。回顾了人口统计学、临床病史、手术/产科病史、用药情况和HRAM检查结果。患者被分为非肥胖（体重指数[BMI]<25kg/m²）、超重（BMI 25-29.9kg/m²）、I类肥胖（30-34.9kg/m²）和II+III类肥胖（>35kg/m²）。进行单变量分析的Fisher精确检验/Student t检验以及多变量分析的逻辑/一般线性回归。
共纳入552名成年人。FI患者的平均BMI较高（27.5对25.9kg/m²，P=0.013）。与非肥胖组相比，II+III类肥胖中FI更为普遍（31.7%对13.2%，P=0.0024），但I类肥胖或超重组并非如此。在控制潜在混杂因素的多变量分析中，II+III类肥胖（调整后的优势比2.89，95%置信区间1.28-6.50，P=0.02）仍然是FI的独立危险因素。在FI患者中，BMI（β系数1.09，P=0.016）和II+III类肥胖（β系数18.9，P=0.027）在多变量回归中均独立预测HRAM上首次直肠感觉量增加。
II+III类肥胖是FI的独立危险因素。在FI患者中，BMI增加和II+III类肥胖与直肠敏感性改变有关。应考虑进行肛门直肠功能测试，以帮助指导肥胖患者中FI的管理。
