Abstract
Background
The presence of bowel urgency and fecal incontinence negatively impacts quality of life in patients with ulcerative colitis (UC).
Aims
We aimed to characterize the assessment of urgency and incontinence in routine clinical care.
Methods
We conducted a retrospective cohort study of prevalent cases of UC evaluated in the University of Calgary IBD Clinic from December 2022 to May 2023, with at least 12 months of follow-up to May 2024. Data on the evaluation of bowel urgency was collected, as were other patient-, disease-, and outcome-related parameters. We aimed to evaluate (1) the proportion of clinic visits where bowel urgency was assessed and documented; (2) the methods for evaluating urgency; (3) the correlation between bowel urgency and other patient-reported outcome measures (including stool frequency and rectal bleeding); and (4) the correlation between bowel urgency and endoscopic appearance.
Results
A total of 274 patients with UC who attended 435 clinic visits were included in this analysis (126 [46.0%] male, mean age at diagnosis 33.2 years [SD 15.5], 104 [40.3%] pancolitis. At the index visit, bowel urgency was evaluated in 160/274 visits (58.4%) and was present in 24.4% (39/160). Most cases were evaluated using the presence/absence of bowel urgency, rather than using a Likert or ordinal scale. In 416 follow-up visits, bowel urgency was assessed in 231 (55.5%) of visits and was present in 75 cases (33.0%). There were moderate-to-strong correlations between bowel urgency and stool frequency (Spearman correlation coefficient 0.54, p<0.001) and rectal bleeding (0.53, p<0.001), but only weak correlation with endoscopic evaluation (Spearman 0.20, p=0.08). Among 136 patients with normal or near normal stool frequency, 16.2% (22/136) had persistent bowel urgency. Among 59 patients with normal or near normal endoscopy, 20.3% (12/59) had persistent bowel urgency.
Conclusions
Bowel urgency remains inconsistently evaluated in clinical care, representing an important area for quality improvement. Although bowel urgency was significantly associated with other patient-reported outcome measures, approximately 1 in 5 patients will have persistent bowel urgency despite minimal endoscopic activity.
Funding Agencies
None