Fecal incontinence in hospitalized bipolar disorder patients: prevalence, gender disparities, and associations with demographic and pharmacological factors.

OBJECTIVE

To investigate the prevalence and associated factors of fecal incontinence among hospitalized patients with bipolar disorder, examining demographic, clinical, and pharmacological determinants to inform evidence-based clinical management strategies.

METHODS

This retrospective cross-sectional study analyzed 200 hospitalized bipolar disorder patients (50% male, 50% female; mean age 37.63 ± 9.67 years) recruited from educational treatment centers affiliated with Shiraz University of Medical Sciences. Fecal incontinence severity was assessed using standardized Vaizey and Wexner scoring systems. Comprehensive data collection included demographic characteristics, psychiatric medication use across four therapeutic classes (antidepressants, mood stabilizers, first- and second-generation antipsychotics), illness duration, bipolar disorder subtypes, and relevant medical history. Statistical analyses employed non-parametric tests, risk calculations, and chi-square associations to identify significant predictors of incontinence outcomes.

RESULTS

The overall fecal incontinence prevalence was 48.5% (97/200 patients), substantially exceeding community rates of 2-8%. Female gender emerged as the strongest predictor (OR = 7.71, 95% CI: 4.11-14.47, p < 0.001), with 72% of women experiencing symptoms compared to 25% of men. Educational attainment showed significant association with incontinence severity (p = 0.008). Age-stratified analysis revealed consistently high prevalence across all age groups (42-52%), challenging typical age-related patterns. Medication-specific analysis demonstrated heterogeneous effects within drug classes: haloperidol (RR = 1.56) and quetiapine (RR = 1.54) increased risk, while olanzapine appeared protective (RR = 0.46). Valproate among mood stabilizers showed increased risk (RR = 1.32), whereas lamotrigine demonstrated complete protection.

CONCLUSION

This study reveals an exceptionally high prevalence of fecal incontinence in hospitalized bipolar disorder patients, with demographic factors proving more predictive than broad medication classes. The profound gender disparity and medication-specific risk profiles necessitate systematic continence screening protocols and individualized pharmacological selection strategies. These findings highlight the critical need for multidisciplinary care approaches integrating psychiatric treatment with specialized continence management to address this previously underrecognized complication affecting nearly half of hospitalized bipolar patients.

CLINICAL TRIAL NUMBER: Not applicable.