Pathophysiology of fecal incontinence in obese patients: A prospective case-matched study of 201 patients
Résumé
BackgroundObesity is an emerging risk factor for fecal incontinence (FI). The aim of this study was to characterize pathophysiologic mechanisms of FI in obese patients compared with non-obese patients in a prospective case-matched study. MethodsThe general characteristics and data of the anorectal manometry and endosonography of patients who were evaluated for FI at a single institution from 2005 to 2015 were prospectively assessed. Fecal incontinence was defined by a Cleveland Clinic Incontinence Score (CCIS) >4. Obesity was defined by a body mass index 30kg/m(2). Obese patients were case-matched with two age- and sex-matched non-obese patients. Key ResultsA total of 201 patients were included (67 obese matched with 134 non-obese). The CCIS, Knowles-Eccersley-Scott Symptom Constipation Score and quality of life score were comparable between obese and non-obese patients with FI. Factors significantly associated with obesity in FI patients were cholecystectomy (odds ratio [OR]=3.45 [1.19-10.32], P=.0230), irritable bowel syndrome - diarrhea (OR=2.94 [1.22-7.19], P=.0158), upper part of the anal canal resting pressure 22mmHg (OR=3.45 [1.45-8.76], P=.0045), maximum rectal tolerable volume 240mL (OR=3.14 [1.34-7.54], P=.0082), and abdominal pressure 28mmHg (OR=2.75 [1.13-7.33], P=.0248) by multivariate analysis. Conclusions & InferencesObese patients with FI had a comparable severity of FI to that of non-obese patients with FI. Regarding obesity in patients with FI, physicians should focus on stool consistency.