Low FODMAP Diet Reduces Symptoms of Fecal Incontinence

Patients with fecal incontinence (FI) and loose stool can decrease their likelihood of experiencing symptoms if they follow a diet low in fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP), according to findings from a retrospective review presented at the American College of Gastroenterology’s Annual Meeting 2018.

“Our study opens the door to the possibility of an entirely new treatment for patients with FI and loose stool who have limited effective options,” said Stacy Menees, MD, who is an assistant professor in the division of gastroenterology and hepatology at the University of Michigan and is a staff physician at the VA Ann Arbor Healthcare System in Michigan.

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Loose stool is a risk factor for the development of FI. Patients with FI often experience diarrhea and urgency, side effects that a diet high in FODMAP promotes.

For their study, Menees and colleagues evaluated the medical records of patients with FI who were assessed in the Michigan Bowel Control Program clinic between August 2012 and December 2017. 

A total of 65 patients with fecal incontinence and loose stool were recommended to start a low FODMAP diet and underwent formal dietary instruction with a dietician from Michigan Medicine.

“Coupled with observations from Monash University and our own group that the low FODMAP diet can improve stool consistency in patients with IBS-D, we hypothesized that the low FODMAP diet might benefit patients with loose stools and FI,” Menees said.

Data from the chart review indicated that 60.5% reported FI daily, 37.8% reported FI weekly and 4.6% reported monthly FI. 

Reduced FI symptoms were noted in 64.6 % of patients prescribed the low FODMAP diet. 

Among all patients, 20% had a prior cholecystectomy, 28% had a prior history of irritable bowel syndrome, and 9.2% had inflammatory bowel disease.

The researchers did not observe any significant demographic or clinical characteristics to predict response to a low FODMAP diet.

Menees said patients are often looking for more natural solutions to various gastrointestinal problems.

“Diet therapies allow patients to be more engaged and in control of their treatment plan,” she said.

The next step in the research is a randomized controlled trial.

“We are currently finishing a pilot, randomized controlled trial comparing low FODMAP diet vs psyllium in patients with FI and loose stool,” Menees said.

—Melinda Stevens

Reference:
Menees SB, Chandhrasekhar D, Liew EL, Chey WD. A low FODMAP diet may reduce symptoms in patients with fecal incontinence. Paper presented at: American College of Gastroenterology Annual Meeting 2018; October 5-10, 2018; Philadelphia, PA. https://www.eventscribe.com/2018/ACG/fsPopup.asp?Mode=presInfo&PresentationID=442111. Accessed October 17, 2018.