Predicting the patients who will struggle with anal incontinence: sensitivity to disgust matters

Quality of life varies in patients with anal incontinence. The severity of symptoms is a surprisingly modest predictor, but they reliably elicit disgust. The current work assessed prospectively whether dispositional sensitivity to disgust predicted the quality of life in patients with anal incontinence.

Seventy-five patients with anal incontinence identified from the waiting list for the pelvic floor clinic at the Greenlane Clinical Centre, Auckland, New Zealand, completed questionnaires assessing symptom severity (Fecal Incontinence Severity Index) and disgust sensitivity (Disgust Sensitivity-Revised scale) prior to a first appointment. Three months later incontinence-specific (Fecal Incontinence Quality of Life Scale, FI QLS) and general quality of life (World Health Organization Quality of Life-BREF, WHOQOL-BREF) were assessed.

Greater severity of symptoms prospectively predicted lower incontinence-specific quality of life (FI QLS lifestyle domain) and lower general quality of life (WHOQOL-BREF environmental domain). Greater disgust sensitivity predicted poorer psychological and environmental well-being, and moderated the link between symptom severity and outcome. Persons low in disgust sensitivity reported a higher quality of life when symptom severity was low, but those with a high disgust sensitivity had a low quality of life regardless of symptom severity.

The functional status of patients with anal incontinence explains some but not all of the variation in quality of life. Emotional factors such as disgust appear to have a role. Disgust sensitivity warrants further attention.