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Fecal Urgency: Clinical and Manometric Characteristics in Patients With and Without Diarrhea

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Abstract

Background

Fecal urgency is classically associated with diarrhea, but is also common in individuals with normal bowel habits or constipation. Its etiology, particularly in non-diarrhea individuals, is unclear.

Methods

We examined data from 368 individuals with and without diarrhea who underwent three-dimensional high-resolution anorectal manometry and balloon expulsion test. All patients completed the Rome III constipation module and the pelvic floor distress inventory (PDFI-20) survey. Patients were considered to have fecal urgency if they reported being bothered “moderately” or “quite a bit” by it in the past 3 months.

Results

A total of 103 patients (28.0%) met our definition of fecal urgency. These patients were significantly more likely to meet criteria for irritable bowel syndrome and to report fecal incontinence, urinary incontinence, and diarrhea. Fecal urgency was associated with rectal hypersensitivity in those with diarrhea, but not in those without diarrhea. Fecal urgency was associated with urinary urge incontinence in those without diarrhea, but not those with diarrhea.

Conclusions

In patients with diarrhea, fecal urgency is associated with rectal hypersensitivity, whereas in patients without diarrhea, fecal urgency is associated with urinary urge incontinence. This suggests that fecal urgency has different pathophysiological mechanisms in patients with different underlying bowel habits.

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Funding

Research reported in this publication was supported by the National Institutes of Health under Award Number R01AT00857303 and T32DK007760

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Vikram Rangan, Judy Nee, Prashant Singh, Sarah Ballou, Johanna Iturrino, William Hirsch & Anthony Lembo

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  1. Vikram Rangan
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  2. Judy Nee
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  3. Prashant Singh
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  4. Sarah Ballou
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  5. Johanna Iturrino
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  7. Anthony Lembo
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Contributions

AL and VR designed the research study. VR, PS, and WH analyzed the data. VR, JN, and PS wrote the paper. JN, PS, JI, SB, and AL provided key editorial input into the paper

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Correspondence to Vikram Rangan.

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Rangan, V., Nee, J., Singh, P. et al. Fecal Urgency: Clinical and Manometric Characteristics in Patients With and Without Diarrhea. Dig Dis Sci 65, 3679–3687 (2020). https://doi.org/10.1007/s10620-020-06349-5

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  • DOI: https://doi.org/10.1007/s10620-020-06349-5

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