Rachel E Andrew, MD, Katelin Mirkin, MD, Evangelos Messaris, MD, PhD, FACS, Frances J Puleo, MD, PhD, FACS. Penn State Hershey Medical Center
Purpose: Patients with fecal incontinence often have life-long difficulty controlling symptoms of this debilitating condition. There is recent interest in surgical interventions through which successful treatment is considered to be a 50% reduction in symptoms. The aim of this study was to evaluate long-term efficacy of dietary fiber supplementation (DFS) as the sole interventional therapy for patients with fecal incontinence (FI).
Methods: Patients with the diagnosis of fecal incontinence ICD-9 code 787.6 were identified at a single institution (2012-2015). Two colorectal surgeons utilized psyllium seed husk (two tablespoons every morning, 30gms) and at least 64 ounces of water daily as initial treatment of patients with fecal incontinence. Patients were evaluated through a mailed survey to assess efficacy of DFS at greater than one year following initiation of treatment. Pre-treatment vs. post-treatment Pescatori and Wexner scores were compared by paired t-test.
Results: 55 patients (41 females, 74.5%) underwent treatment with DFS. Mean patient age was 61.7 ± 13.3 years. Patients were evaluated after initiation of treatment at one month as an outpatient and again at greater than one year through a mailed survey. Wexner and Pescatori scores were used to evaluate efficacy of treatment. At one month, 60% (Wexner) and 38.2% (Pescatori) of patients showed greater than 50% improvement in their FI symptoms (p=0.001). The results of the survey at one year were not as promising. Fifty patients were sent surveys asking them to evaluate their symptoms before and after initiation of treatment with DFS. Fifteen patients responded to the survey. The average reported Pescatori and Wexner scores prior to treatment were 4.9 ± 0.9 (range 3-6) and 11.4 ± 4.6 (range 3-20) respectively. Following DFS, the average Pescatori and Wexner scores decreased (3.4 ± 1.5, and 6.6 ± 5.4 respectively). At one year post-intervention, 46% (Wexner) and 20% (Pescatori) of patients showed greater than 50% improvement in their FI symptoms. On average, there was a 28% reduction in symptoms per the Pescatori score and a 44% reduction in symptoms per the Wexner score.
Conclusions: The use of dietary monotherapy is an inexpensive and well-tolerated intervention for the treatment of fecal incontinence, but the effects may not endure with long-term treatment. Though the outcomes of DFS at one month may be equivalent to those of surgical intervention, with a greater than 50% reduction in symptoms, DFS may not provide long-term reduction in symptoms when used as a sole therapy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78849
Program Number: P255
Presentation Session: Poster (Non CME)
Presentation Type: Poster
