Functional Bowel Disease
Award: Category Award (Functional Bowel Disease)
Introduction: Fecal incontinence (FI) is a common complaint, and is often associated with diarrhea and urgency. Foods that are high in fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP) cause symptoms of diarrhea and urgency. Thus, assessing the impact of a low FODMAP diet in patients with FI due to loose stool is needed. The aim of this study was to assess the impact of a low FODMAP diet on the occurrence of FI due to loose stool. We hypothesize that patients with FI due to loose stool will have reduction in FI episodes with a low FODMAP diet.
Methods: Retrospective chart review study of patients with FI seen in the Michigan Bowel Control Program clinic between August 2012 and December 2017. Patients who had FI with loose stool without red flag signs, who were recommended a low FODMAP diet and underwent formal dietary instruction with a Michigan Medicine dietician were included. Descriptive statistics and bivariate analysis with chi-square and student’s t test were performed with SAS 9.4.
Results: 65 patients with FI who underwent formal dietary teaching were included. 88% were Caucasian and 87% were women with a mean age of 62 (+14) yrs. Additionally, chart review showed that 35% had FI daily, 21.5% had FI weekly and 5% had FI monthly. Mean Bristol stool scale (BSS) was 4.6 (+1.2). 20% had a prior cholecystectomy, 28% had a prior history of irritable bowel syndrome, 9.2% had inflammatory bowel disease and none had celiac disease. 63% (42) patients had reported a reduction in their FI symptoms with low FODMAP diet. There was no demographic or clinical characteristic that predicted response to a low FODMAP diet.
Discussion: Conclusions: In this case series, dietary manipulation with low FODMAP diet was a useful tool to treat patients who suffer from fecal incontinence due to loose stool. Further confirmatory, prospective, randomized controlled trials are required to see the true efficacy of a low FODMAP diet in patients who suffer with FI.