Dietary fiber supplementation for fecal incontinence: a randomized clinical trial.

Research in nursing & health
Oct 2014
Citations:117
Influential Citations:5
Interventional (Human) Studies
84
S2 IconPDF Icon

Enhanced Details

Methods
Parallel-group, placebo-controlled, single-blind randomized clinical trial. Participants: community-dwelling adults ≥18 years with fecal incontinence of loose or liquid feces at least twice in a two-week period; able to read and write English, toileting independently; majority female and white; mean age around 62; 206 randomized, 189 completed.
Intervention
16 g total dietary fiber per day for 32 days; delivered via two juice mixtures (270 mL each) providing 7 g fiber/day and two muffins providing 9 g fiber/day; dosing started with a 6-day ramp-up (increase by one-third every 2 days) and then maintained for 32 days; supplements tested were sodium carboxymethylcellulose (CMC), gum arabic (GA), and psyllium, with a placebo; taken daily at morning and evening meals with at least 150 mL of other fluids; placebo matched in appearance to active supplements.
Results
Psyllium reduced fecal incontinence frequency versus placebo (weekly FI frequency during supplementation: 2.5 vs 5.5 episodes/week; ~51% reduction). Psyllium also reduced FI severity by ~54% relative to placebo. Gum arabic showed no significant difference from placebo. Carboxymethylcellulose increased FI frequency and was associated with more GI symptoms (belching, bloating, flatus, fullness, abdominal cramps). Quality of life did not differ among groups. A gel formed in feces only in the psyllium group, suggesting a mechanism for FI improvement. Authors conclude psyllium may reduce FI frequency in community-living individuals and could be part of conservative FI management; GA and CMC are not beneficial in this context.
Limitations
Short 32-day intervention; single-blind design; generalizability limited to community-dwelling adults with FI of loose/liquid stools; composite FI severity score not previously validated; FIQL may lack sensitivity to detect short-term QoL changes; dye-marker methodology could not be fully implemented due to palatability concerns; higher attrition in psyllium and CMC groups; dietary variation despite analyses.

Abstract

Dietary fiber supplements are used to manage fecal incontinence (FI), but little is known about the fiber type to recommend or the level of effectiveness of such supplements, which appears related to the fermentability of the fiber. The aim of this s...