Food-insecure women have greater odds of fecal incontinence

Food insecurity among women was associated with a higher likelihood of fecal incontinence, even when accounting for diet, according to data published in the American Journal of Obstetrics & Gynecology.

“The mechanisms by which food insecurity may affect fecal incontinence are unclear,” Chihiro Okada, BS, an MD student at Albert Einstein College of Medicine in New York City, and colleagues wrote. “Our findings suggest that food insecurity likely signifies more than simply the nutritional value of foods consumed, and thereby likely impacts fecal incontinence through a mechanism independent of diet. Instead, food insecurity may represent greater social and environmental stressors which could, in turn, influence fecal incontinence disease burden.”

Okada and colleagues analyzed data from women who participated in the National Health and Nutrition Examination Survey from 2005 to 2010. Participants reported past-year food security through the 18-question Household Food Security Survey Module and fecal incontinence within the past month through the Fecal Incontinence Severity Index. Fecal incontinence was defined as “any report of accidental leakage of mucus, liquid or solid stool,” according to the study.

In total, 3,216 women — representing about 130 million U.S. women — completed the questionnaires, among whom 10.9% reported fecal incontinence.

There were no differences in dietary intake between women with and without fecal incontinence. Between women with and without food security, those who were food insecure reported consuming more carbohydrates and sugar and less fiber, alcohol, protein and caffeine. Among food-insecure women, those with fecal incontinence had consumed more calories and had a greater total fats intake.

Controlling for age, race, BMI, comorbidities and dietary factors, food-insecure women were twice as likely to report fecal incontinence compared with food-secure women (adjusted OR = 1.76; 95% CI, 1.17-2.66).

Subgroup analyses showed that food-insecure women who identified as Hispanic (aOR = 2.65; 95% CI, 1.01-6.88) and those who had a BMI less than 30 kg/m² (aOR = 2.68; 95% CI, 1.33-5.41) had greater odds for fecal incontinence compared with their counterparts.

Additionally, Okada and colleagues identified a dose-response relationship between food insecurity and fecal incontinence, with every one-point increase in food insecurity score corresponding with a 9% increased odd of fecal incontinence (aOR = 1.09; 95% CI, 1.03-1.17).

“Understanding food insecurity and the potential influence of other social determinants of health on fecal incontinence may be critical for developing treatments that address health equity, as well as screening methods that target at-risk populations with the end goal of ideally alleviating symptom burden and improving quality of life,” Okada and colleagues wrote. “Future studies assessing the association between specific social needs and fecal incontinence symptom severity, treatment seeking behavior and treatment outcomes as well as the potential impact of addressing unmet social needs via community outreach efforts on incidence, symptom severity and treatment efficacy are needed.”