title: Vitamin D deficiency is associated with increased fecal incontinence symptoms.
abstract: OBJECTIVE
  Vitamin D is an important micronutrient in muscle function. We hypothesize that vitamin D deficiency may contribute to fecal incontinence (FI) symptoms by affecting the anal continence mechanism. Our goal was to characterize the association of vitamin D deficiency as a variable affecting FI symptoms and its impact on health-related quality of life (HR-QoL).
  
  
  METHODS
  This case-control study assessed women seen at a tertiary-care referral center. Participants were identified as having had a serum vitamin D level obtained within a year of their visit: cases were women presenting for care for FI symptoms; controls were women without any pelvic floor symptoms presenting to the same clinical site for general gynecologic care. Cases completed the Modified Manchester Health Questionnaire (MMHQ) and the Fecal Incontinence Severity Index to measure symptom severity and burden on QoL.
  
  
  RESULTS
  Among the 31 cases and 81 controls, no demographic or medical differences existed. Women with FI had lower vitamin D levels (mean 29.2 ± 12.3 cases vs. 35 ± 14.1 ng/ml controls p = 0.04). The odds of vitamin D deficiency were higher in women with FI compared with controls [odds ratio (OR) 2.77, 95 % confidence interval (CI) 1.08-7.09]. Among cases, women with vitamin D deficiency (35 %) had higher MMHQ scores, indicating greater FI symptom burden [51.3 ± 29.3 (vitamin D deficient) vs. 30 ± 19.5 (vitamin D sufficiency), p = 0.02]. No differences were noted for FI severity, p = 0.07.
  
  
  CONCLUSIONS
  Vitamin D deficiency is prevalent in women with fecal incontinence and may contribute to patient symptom burden.
authors.affiliation: Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC, USA, cparkera@wakehealth.edu.
authors.forename: Candace Y
authors.initials: CY
authors.lastname: Parker-Autry
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Gleason
authors.forename: Russell L
authors.initials: RL
authors.lastname: Griffin
authors.forename: Alayne D
authors.initials: AD
authors.lastname: Markland
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
mesh_terms: D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D019160:Endosonography; D005242:Fecal Incontinence / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D