The relationship between fecal incontinence and food insecurity in United States women: an analysis of 2005–2010 National Health and Nutrition Examination Survey

Chihiro Okada, Joseph I. Kim, Michal L. Melamed, Nitya Abraham, Priyanka Kadam Halani

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Fecal incontinence is a prevalent debilitating pelvic floor disorder characterized by the involuntary loss of stool. Fecal incontinence is known to be associated with constipation and loose stool, advancing age, chronic comorbidities, and previous anorectal trauma, among other biologic risk factors. The relationship between social determinants of health, such as food insecurity, and fecal incontinence is not well elucidated. Objective: This study aimed to investigate the association between fecal incontinence and food insecurity using a nationally representative sample of US adult women. Our secondary aim was to examine the role of diet by assessing dietary differences between participants with and without fecal incontinence and between food-insecure women with and without fecal incontinence. Study Design: This study analyzed data from the National Health and Nutrition Examination Survey, a nationally representative series of cross-sectional health surveys. Fecal incontinence was defined as accidental leakage of stool within the last 30 days. Food insecurity was assessed using the household food security measure created by the US Department of Agriculture. Dietary data from the National Health and Nutrition Examination Survey dietary interviews titled “Individual Foods, First Day” and “Individual Foods, Second Day,” which estimate the foods and drinks consumed in the preceding 24 hours, were pooled. The association between fecal incontinence and food insecurity was analyzed using logistic regression after controlling for patient characteristics. Results: Overall, 3216 women were included, representing nearly 130 million US women. Of these women, 10.9% had fecal incontinence. There was no significant difference in diet between women with and without fecal incontinence (p>0.05). Food-insecure women in the overall sample reported higher carbohydrate and sugar intake and lower fiber and alcohol intake (all P<.05). Among food-insecure women, those with fecal incontinence had higher calorie and total fats intake than those without fecal incontinence; there was no significant difference in other dietary components (p>0.05). There was a significant association between food insecurity and fecal incontinence, such that women with food insecurity had higher odds of fecal incontinence after adjusting for patient characteristics and diet (odds ratio, 1.76; 95% confidence interval, 1.17–2.66; P=.008). Conclusion: Food insecurity was associated with fecal incontinence even after accounting for diet. Understanding the role of social determinants of health in fecal incontinence symptomatology and treatment is important to potentially alleviate symptom burden and improve the quality of life in at-risk populations.

Original languageEnglish (US)
Pages (from-to)449.e1-449.e13
JournalAmerican journal of obstetrics and gynecology
Volume228
Issue number4
DOIs
StatePublished - Apr 2023

Keywords

  • accidental bowel leakage
  • fecal incontinence
  • food insecurity
  • social determinants of health

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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