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Obesity May Play a Role in Defecation Disorders


Obesity is significantly associated with fecal incontinence (FI), fecal urgency, and large rectoceles, as well as higher anal and rectal resting pressures, new research suggests.


  • The cross-sectional study involved 1155 patients (84% women) who were referred to the Royal London Hospital Lower Gastrointestinal Physiology Unit.

  • All patients met Rome IV criteria for FI and/or functional constipation.

  • Clinical history, symptoms, and anorectal physiologic test results were analyzed.


  • Two thirds (66.5%) of patients with FI and/or functional constipation were overweight or obese.

  • Obesity was significantly associated with FI to liquid stools (odds ratio [OR], 1.96), fecal urgency (OR, 1.54), urge FI (OR, 1.68), and vaginal digitation (OR, 2.18).

  • Higher proportions of patients with obesity had Rome criteria–based FI or coexistent FI and functional constipation, compared with peers with overweight and those of normal body mass index (BMI).

  • There was a positive linear association between BMI and anal resting pressure (P = .0003).

  • Patients with obesity more often had large clinically significant rectoceles (OR, 2.62).


“Obesity impacts specific defecatory (mainly FI) and prolapse symptoms and pathophysiologic findings (higher anal resting pressure, significant rectocele). Prospective studies are required to determine if obesity is a modifiable risk factor for FI and constipation,” the authors write.


The study was led by Pam Chaichanavichkij, MBChB, with the National Bowel Research Centre and GI Physiology Unit, Queen Mary University of London, United Kingdom. It was published online July 7 in the American Journal of Gastroenterology.


The study sample consisted mostly of female patients from a single tertiary center, so the findings may not be generalizable to male patients or the general population. The investigators were unable to control for potential confounders, such as diet and exercise, which could influence the association between obesity and defecation disorders.


The study had no specific funding. The authors have disclosed no relevant conflicts of interest.

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