Fecal Incontinence Drives the Psychosocial Burden in Patients with Dual Incontinence.

Abstract

Introduction and hypothesis: Urinary incontinence (UI) and fecal incontinence (FI) are debilitating conditions affecting patients' quality of life (QOL). Dual incontinence (DI) of both urine and stool represents an additional burden. We compare the physical and mental health of patients with UI, FI, and DI. We hypothesize that DI might be associated with increased psychosocial burden.

Methods: Patients completed online questionnaires on sociodemographics, urinary and bowel symptoms, and psychosocial comorbidity. The Patient-Reported Outcomes Measurement Information System (PROMIS) measures physical and mental health, anxiety, depression, stress, and instrumental support was used to assess psychosocial burden. Responses including PROMIS measures were compared between those with no incontinence (NI), those with UI, those with FI, and those with DI.

Results: A total of 3620 respondents completed the study, the majority of whom were female (78%), and white (84%). Age and BMI were different among groups, with the DI group having the oldest mean age (54 years) and highest mean BMI (29 kg/m²). PROMIS scores were significantly different across groups, with DI having the lowest physical and mental health scores (i.e. poorest health), and highest stress and depression scores (i.e. greatest burden). This remains true when DI is compared only with NI or UI; however, results were similar for most measures between DI and FI, suggesting that the burden might largely be driven by FI.

Conclusions: Dual incontinence results in worse patient-reported physical and mental health, and higher psychosocial burden. In our cohort, it appears that the psychosocial burden may be largely driven by the FI component of DI. Thus, addressing FI in our patients with DI may help improve QOL.