Bowel urgency in inflammatory bowel disease: A concept analysis
Daniele Napolitano1, Mattia Bozzetti2, Valentina Vanzi3
1CEMAD, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Background:
Bowel urgency is a distressing and often underrecognized symptom of inflammatory bowel disease (IBD). It represents a sudden and compelling need to defecate that is difficult to defer and strongly affects patients' quality of life. Despite its clinical importance, the concept of bowel urgency remains poorly characterized and inconsistently measured across studies.
Aims:
This review aims to clarify the conceptual boundaries of bowel urgency, summarize recent clinical and mechanistic evidence, and provide a framework to guide its assessment and management in clinical practice and research.
Methods:
A narrative concept analysis was conducted using Walker and Avant's 8-step method. Evidence from clinical, physiological, and patient-reported outcome studies published between 2016 and 2025 was integrated across major databases (MEDLINE, PsycInfo, Scopus, Web of Science) to identify defining attributes, antecedents, and consequences of bowel urgency in IBD.
Results:
Seven defining attributes were identified: sudden onset, perceived uncontrollability, compressed time to toilet, fear or risk of incontinence, anticipatory anxiety, behavioral planning or avoidance, and persistence despite inflammatory quiescence. Biological antecedents include rectal inflammation, hypersensitivity, and altered pelvic floor function, while psychosocial factors such as vigilance and anxiety contribute to chronicity. Consequences extend from emotional distress and reduced social participation to increased healthcare utilization. Current tools, including the Urgency Numeric Rating Scale, capture intensity but fail to reflect multidimensional impact.
Conclusions:
Bowel urgency is a multidimensional clinical construct with physiological, psychological, and behavioral components. Its systematic assessment should become a routine element of IBD care and a standardized endpoint in clinical trials. Developing and validating a multidimensional, IBD-specific urgency measure would bridge symptom monitoring and patient-centered outcomes.
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