Medical–behavioural therapy may improve faecal incontinence outcomes for some patients

Medical–behavioural therapy helps reduce the frequency of incontinence (FI) episodes and improve quality of life in less than a quarter of patients with moderate-to-severe FI, as shown in a study.

The study was conducted across five centres in the US and included 260 adults with moderate-to-severe FI. These participants received individualized medical–behavioural therapy, which involved dietary modifications, medications, and pelvic floor exercises, for up to 3 months.

The primary outcome was response, defined as a ≥75-percent reduction in FI frequency after 4 weeks of medical-behavioural therapy. Secondary outcomes included 3-month FI, bowel habits, and FI-related quality of life.

At baseline, the participants had one episode of FI per day on average, more than one-third of bowel movements were incontinent, and nearly 25 percent had undergone anorectal procedures and/or colon resection.

A total of 60 participants (23 percent) showed response to medical–behavioural therapy at 1 month, with response sustained in 39 participants (15 percent) at 3 months. FI-QoL significantly improved in sustained responders (p≤0.006).

Greater reductions in FI frequency were associated with a higher likelihood of exceeding minimal clinically important differences (MCIDs) for FI frequency (p<0.006) and for FI-QoL lifestyle and coping subscores (p≤0.04).

In multivariable analysis, the likelihood of a response was greater among participants with higher baseline FI frequency and no external anal sphincter defects (p=0.0002). The decline in FI frequency for any given reduction in Bristol stool score was greater among participants with more frequent FI at baseline (p=0.002).