Photo Credit: peakSTOCK

The following is a summary of “Clinical Impact of Obesity in Patients With Disorders of Defecation: A Cross-Sectional Study of 1,155 Patients,” published in the December 2023 issue of Gastroenterology by Chaichanavichkij, et al.

Obesity has become a global epidemic, yet its precise clinical impact on symptoms related to fecal incontinence (FI) and constipation, along with the underlying anorectal pathophysiology, remained uncertain.

The cross-sectional study included consecutive patients meeting Rome IV criteria for FI and/or functional constipation, collecting data on body mass index (BMI). The study, conducted between 2017 and 2021 at a tertiary center, analyzed clinical history, symptoms, and anorectal physiologic test results categorized according to BMI.

In total, 1,155 patients (84% female) were analyzed, with 33.5% having a normal BMI (33.5%), 34.8% overweight, and 31.7% obese. Obese patients exhibited higher odds of FI to liquid stools (69.9% vs. 47.8%, OR 1.96 [CI: 1.43–2.70]), use of containment products (54.6% vs. 32.6%, OR 1.81 [CI: 1.31–2.51]), fecal urgency (74.6% vs. 60.7%, OR 1.54 [CI: 1.11–2.14]), urge FI (63.4% vs. 47.3%, OR 1.68 [CI: 1.23–2.29]), and vaginal digitation (18.0% vs. 9.7%, OR 2.18 [CI: 1.26–3.86]). A higher proportion of obese patients had Rome criteria-based FI or coexistent FI and functional constipation (37.3%, 50.3%) compared with overweight patients (33.8%, 44.8%) and patients with a normal BMI (28.9%, 41.1%). There was a positive linear association between BMI and anal resting pressure (β 0.45, R2 0.25, P = 0.0003), although the odds of anal hypertension were not significantly higher after the Benjamini-Hochberg correction. Obese patients were more likely to have a large clinically significant rectocele (34.4% vs. 20.6%, OR 2.62 [CI: 1.51–4.55]) compared with patients with a normal BMI.

Obesity demonstrated a significant impact on specific defecatory symptoms, primarily FI, and certain pathophysiologic findings such as higher anal resting pressure and significant rectocele. Prospective studies were warranted to explore whether obesity represents a modifiable risk factor for FI and constipation.

Source: journals.lww.com/ajg/abstract/2023/12000/the_clinical_impact_of_obesity_in_patients_with.28.aspx