title: Predicting the patients who will struggle with anal incontinence: sensitivity to disgust matters.
abstract: OBJECTIVE
  Quality of life varies in patients with anal incontinence. The severity of symptoms is a surprisingly modest predictor, but they reliably elicit disgust. The current work assessed prospectively whether dispositional sensitivity to disgust predicted the quality of life in patients with anal incontinence.
  
  
  METHODS
  Seventy-five patients with anal incontinence identified from the waiting list for the pelvic floor clinic at the Greenlane Clinical Centre, Auckland, New Zealand, completed questionnaires assessing symptom severity (Fecal Incontinence Severity Index) and disgust sensitivity (Disgust Sensitivity-Revised scale) prior to a first appointment. Three months later incontinence-specific (Fecal Incontinence Quality of Life Scale, FI QLS) and general quality of life (World Health Organization Quality of Life-BREF, WHOQOL-BREF) were assessed.
  
  
  RESULTS
  Greater severity of symptoms prospectively predicted lower incontinence-specific quality of life (FI QLS lifestyle domain) and lower general quality of life (WHOQOL-BREF environmental domain). Greater disgust sensitivity predicted poorer psychological and environmental well-being, and moderated the link between symptom severity and outcome. Persons low in disgust sensitivity reported a higher quality of life when symptom severity was low, but those with a high disgust sensitivity had a low quality of life regardless of symptom severity.
  
  
  CONCLUSIONS
  The functional status of patients with anal incontinence explains some but not all of the variation in quality of life. Emotional factors such as disgust appear to have a role. Disgust sensitivity warrants further attention.
authors.affiliation: Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.
authors.forename: L M
authors.initials: LM
authors.lastname: Reynolds
authors.forename: I P
authors.initials: IP
authors.lastname: Bissett
authors.forename: N S
authors.initials: NS
authors.lastname: Consedine
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004644:Emotions; D005242:Fecal Incontinence / Q000523:psychology*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Disgust; emotion; faecal incontinence; incontinence severity; quality of life