S1155 Characterization of Stool and Bowel Symptoms in Patients With Fecal Incontinence and Healthy Subjects: A Prospective Multi-Center Study

Introduction: Unpredictable stool leakage and irregular bowel movements (BMs) are characteristic symptoms of patients with fecal incontinence (FI). However, these events are difficult to record, and patients' recall of symptoms is often unreliable. Traditionally, paper stool diaries have been used, but we have validated an electronic FI stool diary that is perceived as more user-friendly and convenient. This app has both clinical and research modules. Aim: To prospectively assess the clinical utility of FI stool diary app in patients with FI and healthy subjects across 2 centers. Methods: FI Patients (≥1 leakage/week) and healthy subjects from 2 centers were asked to complete a prospective 1-week validated FI stool diary app on a mobile phone. Subjects were asked to record the time of BMs/Leakage, urgency, amount of leakage, activities during leakage, stool consistency (Bristol stool, type 1-7), sensation before leakage, use of pads, BMs induced by, complete BMs, urinary and gas leakage, and medication used for stool. The app’s research module was used for data analysis to compare between FI patients and healthy subjects. Results: 179 FI patients (F/M = 147/32, age: 26-87 yrs.) and 43 healthy subjects (F/M = 30/13, 22-75 yrs.) participated. Mean FI episodes were 6.6 ± 0.4. The amount of leakage was rated as mild (52.6%), moderate (37.2%) or severe (8.5%). Leakage mainly occurred during sitting or resting (40.6%) and household chores (16.5%). About 37.4% of FI patients reported no awareness of leakage whereas 27.1% had normal urge and 33.4% had strong urgency. Urinary leakage was reported by 45.3% and gas leakage by 70.4% of FI patients, and almost none in healthy subjects. The no. of BMs, BMs with urgency, nocturnal BMs, liquid stool, and incomplete BMs were all significantly higher in FI patients compared to healthy subjects (P < .001). Conclusion: This large study demonstrates the feasibility and usefulness of the FI stool diary app and its utility to evaluate and characterize stool and bowel symptoms. There were significant differences in stool characteristics between FI patients and healthy subjects. Also, FI patients reported significant gas and urinary leakage. The clinical module of the app facilitates symptom assessment and guides physician management, whereas the research module provides detailed and granular information for baseline and/or post-intervention assessment. The FI stool diary APP is a useful clinical and research tool for the management of FI patients.