Sensation of Incomplete Evacuation in Patients With Fecal Incontinence: A Cross-Sectional Study of a Tertiary Referral Cohort.

INTRODUCTION

Many patients with fecal incontinence (FI) report a sensation of incomplete evacuation (SIE), a symptom that may have clinical relevance but remains insufficiently characterized. This study compared symptoms, categorized high-resolution anorectal manometry (HRAM), and health-related quality of life (HRQL) in patients with FI alone and those with FI and SIE.

METHODS

In this cross-sectional study, 777 adults with FI referred to a tertiary pelvic floor unit (2015-2022) were included. All participants underwent HRAM and completed questionnaires assessing gastrointestinal symptoms and HRQL. Patients were categorized as FI only or FI with SIE.

KEY

RESULTS

Of 777 patients, 585 (75%) reported SIE. Compared with the FI-only group (n = 192, 25%), patients with SIE had higher stool frequency (mean (SD) 2.9 (2.8) vs. 2.0 (1.7)), more prolonged defecation time (≥ 20 min: 14% vs. 6%), and more frequent straining (≥ 20 min: 14% vs. 3%) (all p < 0.001). Weekly soiling was more prevalent (92% vs. 86%, p = 0.02), as were bladder emptying difficulties, abdominal, and anorectal pain. FI severity and frequency did not differ between groups (p > 0.05). The proportion of patients across categorized HRAM parameters was similar (all p > 0.05). HRQL was consistently worse across all domains in patients with additional SIE (all p < 0.001).

CONCLUSIONS

Coexisting SIE was associated with greater symptom burden, more pain, and substantially impaired HRQL in patients with FI, despite comparable distributions across categorized HRAM parameters and similar FI severity. Recognition of incomplete evacuation is therefore essential in FI care.