The Severity of Fecal Problems Is Negatively Associated With Quality of Life in a Non-Patient Dutch Population

Abstract

BACKGROUND: Constipation and fecal incontinence have a negative influence on quality of life. The association between the severity of fecal problems and quality of life has not been investigated in a non-patient population. OBJECTIVE: To investigate the association between the severity of constipation and fecal incontinence and quality of life in non-patients. DESIGN: A population-based, cross-sectional study. SETTINGS: The study involved 3668 Dutch non-patients. PATIENTS: A survey company conducted a population-wide study of the general Dutch population. Altogether, 5000 Dutch citizens completed the Groningen Defecation and Fecal Continence and Short-Form 36 questionnaires. The data on 3668 respondents without comorbidities that could influence bowel function were included for analysis. MAIN OUTCOME MEASURES: The severity of constipation (Agachan score) and fecal incontinence (Wexner score) in relation to the quality-of-life scores. RESULTS: In the non-patient population (n = 3668), 487 (13.3%) had constipation, 116 (3.2%) had fecal incontinence, and the two fecal problems coexisted in 64 (1.7%). In the multivariable analysis, all quality-of-life domains were negatively associated with the severity of constipation and fecal incontinence. The associations between the severity of constipation and quality of life were stronger (highest: ß = -2.413, 95% CI, -2.681 to -2.145, p = < 0.001) than those of fecal incontinence (highest: ß = -1.280, 95% CI, -1.681 to -.880, p = < 0.001). We also found that a longer duration of bowel complaints coincided with higher severity scores, especially for constipation. Mostly, respondents rated their defecation health as positive, regardless of the severity of their fecal problems. LIMITATIONS: Cross-sectional design. CONCLUSIONS: The severity of constipation and fecal incontinence is significantly associated with reduced quality of life, with the severity of constipation having stronger associations than fecal incontinence. Given respondents' unawareness of their fecal problems and the progressive character thereof, timely intervention is advocated.