P1095 (S0458). - Does Fecal Incontinence Symptom Severity Evaluated by Symptom Summation and Individual Fecal Incontinence Components Predict Rectal Hypersensitivity in a Large Fecal Incontinence Cohort?
Jason Baker, PhD1, William D. Chey, MD, FACG2, Lydia Watts, BS, BA2, Moira Armstrong, BS2, Gabrielle J. Ezell, MS2, Stacy B. Menees, MD, MS3; 1University of North Carolina, Charlotte, NC; 2University of Michigan Health System, Ann Arbor, MI; 3VA Ann Arbor, Ann Arbor, MI
Introduction: Rectal sensation contributes significantly to the process of continence. Rectal hypersensitivity (RH) has been associated with a greater perception to defecate, increase lifestyle restrictions, and decrease quality of life domains in patients with fecal incontinence (FI). RH to rectal sensation measurements during an anorectal manometry (ARM) are often reported by patients with FI. Our hypothesis is that higher self-reported FI symptom severity will be associated with RH. Methods: Retrospective cross-sectional study was conducted on 955 FI patients ≥18 years of age who were referred for ARM at a single tertiary medical center from 6/11 to 3/20. All patients completed the Fecal Incontinence Severity Index (FISI) questionnaire (0-61 scale: higher scores representing greater symptom severity). FISI components, gas (0-12), mucous (0-12), liquid (0-19), and stool (0-18) were scored using the patient validated metrics instead of physician values. RH was defined as balloon distention volume documented in the FI literature: First Sensation (FS) as ≤ 38 ml and Urge-to-Defecate (UD) as ≤ 80 ml. Independent t-tests were performed to assess the mean difference of FISI summation (FISI-Sum) and FISI components (FISI-C) between FI patients categorized as RH vs. normal rectal sensation (NRS) and sex (male vs. female). A p-value of ≤ 0.05 was considered statistically significant. Results: Demographics (N = 955) were as follows: mean age 60.4±14.1 years (19-91), mean BMI 29.3±6.6, 73.6% female, and 90.7% Caucasian. No demographics differences between genders. The mean FISI-Sum and FISI-C scores for entire sample were 35.8±12.5: Gas (10.2±2.7), Mucous (7.9±3.4), Liquid (13.5±4.3), and Stool (12.8±3.6). RH measured by FS and UD criteria for the sample were 29.1% and 49.1%. No significant differences in FISI-Sum and FISI-C related to RH using FS besides Liquid incontinence reported greater severity by NRS (p =0.001) [Table 1]. No significant differences in FISI-Sum and FISI-C between the RH and NRS groups in males. Females in the NSR group self-reported greater Liquid incontinence (p = 0.003) vs. the RH group measured by FS and no differences between RH and NRS groups using UD. Discussion: Rectal hypersensitivity did not predict FI severity and may reduce the amount of liquid FI in patients. Therefore, the use of anorectal rectal function testing including rectal sensation metrics and rectal sensory re-training are necessary for evaluating and improving defecatory sensations.
Disclosures: Jason Baker indicated no relevant financial relationships. William Chey indicated no relevant financial relationships. Lydia Watts indicated no relevant financial relationships. Moira Armstrong indicated no relevant financial relationships. Gabrielle Ezell indicated no relevant financial relationships. Stacy Menees indicated no relevant financial relationships.