Relationship Between Hemoglobin A1c and Fecal Incontinence in a Nationwide Cohort Study

Gastrointestinal manifestations of diabetes include a variety of symptoms, including fecal incontinence (FI). We investigated the relationship between hemoglobin A1c and FI among US adults in a large, population-based survey.

We identified adults (≥ 20 years) who completed the bowel health questionnaire and had A1c data in the National Health and Nutrition Examination Survey from 2005 to 2010 (N = 13,787). FI was defined as any involuntary loss of mucus, liquid, or solid stool during the last 30 days. Adjusted odds ratios (aORs) for FI were estimated in a multivariable logistic model according to A1c. Subgroup analyses examined relevant characteristics.

We identified 1283 (9.3%) adults with FI. A1c was associated with a 26% increase in the odds of FI (crude OR 1.26, 95% CI 1.20-1.33), which persisted after stepwise adjustment for age, demographic factors, and comorbidities (aOR 1.09, 95% CI 1.01-1.17). In subgroup analyses, A1c was associated with FI in diabetes (aOR 1.13, 95% CI 1.01-1.26), women (aOR 1.15, 95% CI 1.02-1.3), those < 65 years of age (aOR 1.17, 95% CI 1.09-1.25), overweight/obesity (aOR 1.1, 95% CI 1.02-1.20), non-white (aOR 1.1, 95% CI 1.01-1.20), and those with solid stool FI (aOR 1.17, 95% CI 1.04-1.32).

Increasing A1c was associated with an increased odds of FI. Our study provides insights into subgroups of patients who may benefit from interventions aimed at glucose control to reduce this risk of FI.