title: Pathophysiology of fecal incontinence in obese patients: A prospective case-matched study of 201 patients.
abstract: BACKGROUND
  Obesity is an emerging risk factor for fecal incontinence (FI). The aim of this study was to characterize pathophysiologic mechanisms of FI in obese patients compared with non-obese patients in a prospective case-matched study.
  
  
  METHODS
  The general characteristics and data of the anorectal manometry and endosonography of patients who were evaluated for FI at a single institution from 2005 to 2015 were prospectively assessed. Fecal incontinence was defined by a Cleveland Clinic Incontinence Score (CCIS) >4. Obesity was defined by a body mass index ≥30 kg/m2. Obese patients were case-matched with two age- and sex-matched non-obese patients.
  
  
  RESULTS
  A total of 201 patients were included (67 obese matched with 134 non-obese). The CCIS, Knowles-Eccersley-Scott Symptom Constipation Score and quality of life score were comparable between obese and non-obese patients with FI. Factors significantly associated with obesity in FI patients were cholecystectomy (odds ratio [OR]=3.45 [1.19-10.32], P=.0230), irritable bowel syndrome - diarrhea (OR=2.94 [1.22-7.19], P=.0158), upper part of the anal canal resting pressure ≥22 mm Hg (OR=3.45 [1.45-8.76], P=.0045), maximum rectal tolerable volume ≥240 mL (OR=3.14 [1.34-7.54], P=.0082), and abdominal pressure ≥28 mm Hg (OR=2.75 [1.13-7.33], P=.0248) by multivariate analysis.
  
  
  CONCLUSIONS
  Obese patients with FI had a comparable severity of FI to that of non-obese patients with FI. Regarding obesity in patients with FI, physicians should focus on stool consistency.
authors.affiliation: Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.|Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.|INSERM U991, Université de Rennes 1, Rennes, France.|CIC 1414, INPHY, Université de Rennes 1, Rennes, France.
authors.forename: C
authors.identifier: http://orcid.org/0000-0001-7354-6301
authors.initials: C
authors.lastname: Brochard
authors.affiliation: Service de Chirurgie Viscérale, Université d'Angers, Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Vénara
authors.affiliation: Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Bodère
authors.affiliation: Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.|CIC 1414, INPHY, Université de Rennes 1, Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Ropert
authors.affiliation: Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.|INSERM U991, Université de Rennes 1, Rennes, France.|CIC 1414, INPHY, Université de Rennes 1, Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Bouguen
authors.affiliation: Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.|INSERM U991, Université de Rennes 1, Rennes, France.|CIC 1414, INPHY, Université de Rennes 1, Rennes, France.
authors.forename: L
authors.initials: L
authors.lastname: Siproudhis
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D019160:Endosonography; D005242:Fecal Incontinence / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011446:Prospective Studies; D011788:Quality of Life; D012007:Rectum / Q000503:physiopathology; D012720:Severity of Illness Index
keywords: fecal incontinence; obesity; pathophysiology