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PHILADELPHIA -- Two-thirds of patients with fecal incontinence associated with loose stool experienced an improvement in symptoms when following a low FODMAP diet, a researcher reported here.

"Fecal incontinence is an underappreciated complaint, and patients often suffer in silence," said Stacy Menees, MD, of the University of Michigan in Ann Arbor, in a presidential plenary session at the

In an earlier, large population-based study of more than 71,000 people, one in seven reported having had fecal incontinence at some point in their lives. Of these, one-third reported fecal incontinence in the last 7 days, which is often associated with diarrhea and loose stool. People with diarrhea have a 5.6-fold higher risk of fecal incontinence, and people with urgency have a more than 8-fold risk of diarrhea.

"So if we are going to help people with fecal incontinence, the key is to concentrate on their stool consistency," Menees said.

A diet that is low in foods that are high in fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) has been shown to relieve symptoms in patients with irritable bowel syndrome, while foods that are high in FODMAPs can cause diarrhea and urgency. High FODMAP foods include fructose-containing fruits such as apples and pears, foods containing fructans, such as onion and garlic, wheat-based foods, and foods containing sorbitol, lactose, and raffinose.

The mechanisms by which FODMAPs influence symptoms are through osmotic effects, drawing water into the stool and accelerating transit time, and through bacterial fermentation in the colon.

To investigate whether a low FODMAP diet could lead to a reduction in fecal incontinence, Menees and her colleagues conducted a retrospective chart review of patients seen in the Michigan Bowel Control Program from 2012 to 2017. The 65 patients included had all received formal dietary instruction in the program.

The majority (87.7%) were women, 93.6% were white, and mean age was 61.9.

Comorbidities included irritable bowel syndrome in 27.7% of those in the study, inflammatory bowel disease in 9.2%, diabetes in 16.9%, and prior cholecystectomy in 20%.

A total of 60.5% reported having episodes of fecal incontinence daily, and 37.8% reported episodes weekly.

On the yes/no dichotomous question as to whether the diet improved their symptoms, 64.5% said yes.

For the FDA's endpoint of a greater than 50% improvement, the response rate was 88.1%, and for a 75% reduction, the response rate was 76.2%. Complete remission was seen in 35.7%.

No demographic or clinical factors seemed to predict response, and there were no serious adverse events in the study.

Onion and garlic were the triggers most often identified.

Limitations of the study included its retrospective design and limited sample size, Menees said. "However, we are nearing completion of a confirmatory, prospective randomized controlled trial in patients with fecal incontinence and loose stools."

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