Urinary Dysfunction Is Common in Patients with Fecal Urgency and May Relate to Altered Rectal Biomechanics

Fecal urgency is a common symptom in both healthy patients and in those with bowel dysfunction. Fecal urgency is often thought to be associated with diarrhea and incontinence; however, a portion of patients present with constipation.

Our aim was to assess for the presence of urinary symptoms in patients with fecal urgency and to elucidate the relationship between colorectal/urinary symptoms and anorectal physiologic parameters.

Patients referred for anorectal function testing between 2019 and 2024 were assessed. Those who underwent anorectal manometry, balloon expulsion test, and rapid barostat bag testing alongside completing the Pelvic Floor Distress Inventory (PFDI) were included. Anorectal physiologic parameters were compared with colorectal/urinary symptom burden ((as measured by the CRAD-8 and UDI-6 subscale of the PFDI).

Fecal urgency was seen in 50.7% of patients. Patients with fecal urgency reported more fecal incontinence (64.4 vs. 15.5%) and urge urinary incontinence (40.3 vs. 21.5%) and had a higher burden of colorectal and urinary symptoms. Their mean resting anal sphincter pressures (68.0 vs. 78.9 mmHg) were lower as were their squeeze (128.9 vs. 162.9 mmHg) and residual pressures (68.6 vs. 82.4 mmHg). Patients with fecal urgency had feeling of urge and sensation at lower balloon volume (131 vs. 153 ml and 81 vs. 107 ml, respectively.

Manometric and biomechanical parameters in patients with fecal urgency, with and without incontinence, are altered. Fecal urgency was associated with higher burden of urinary symptoms, specifically urge incontinence. The correlation between symptoms of fecal and urinary urgency may indicate a shared pathophysiology that requires further study with anorectal physiology and urodynamic testing.