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Comparison of Patient Impact and Clinical Characteristics Between Urgency and Passive Fecal Incontinence Phenotypes

Pahwa, Avita K., MD; Khanijow, Kavita D., MD; Harvie, Heidi S., MD, MBA; Arya, Lily A., MD, MS; Andy, Uduak U., MD

Female Pelvic Medicine & Reconstructive Surgery: July 3, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000603
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Objective To determine if categorizing fecal incontinence (FI) as urgency or passive FI is clinically meaningful, we compared clinical severity, quality of life, physical examination findings, and functional and anatomic deficits between women with urgency and passive FI.

Methods This study is a prospective cross-sectional study of women with at least monthly FI. All women completed the St Mark’s Vaizey and the Fecal Incontinence Quality of Life questionnaires and underwent anorectal manometry and endoanal ultrasound. We compared women with urgency FI to women with passive FI.

Results Forty-six women were enrolled, 21 (46%) with urgency FI and 25 (54%) with passive FI. Clinical severity by Vaizey score did not differ between groups (urgency 11.7 ± 1.6 vs passive 11.0 ± 1.0, P = 0.51). Women with urgency FI had worse median (range) lifestyle and coping scores than passive FI (Fecal Incontinence Quality of Life: lifestyle domain 2.5 [1, 4] vs 3.8 [1, 4], P = 0.04; coping domain 1.7 [1, 3] vs 2.4 [0.9, 4], P < 0.01). Women with urgency FI had higher anal resting and squeeze pressure than passive FI (60 ± 4 mm Hg vs 49 ± 3 mm Hg, P = 0.03; 78 [48, 150] mm Hg vs 60 [40, 103], P = 0.05). Internal anal sphincter defects were more common in women with passive FI (41.7% vs 30.0%, P = 0.53) and external anal sphincter defects more common in women with urgency FI (25% vs 16.7%, P = 0.71), but this did not reach statistical significance.

Conclusions We identified functional and anatomic differences between women with urgency FI and passive FI. Pheonotyping women with FI into these subtypes is clinically meaningful.

From the Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA.

Correspondence: Avita K. Pahwa, MD, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, 220 Zonal Ave, IRD 2020, Los Angeles, CA 90033. E-mail: avita.pahwa@med.usc.edu.

The authors have declared they have no conflicts of interest.

Clinical trials information: Fecal Incontinence Subtypes in Women With Pelvic Floor Disorders, https://clinicaltrials.gov/ct2/show/NCT02772874?term=fecal+incontinence&rank=7, identification number NCT02772874.

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