Fecal Incontinence as a Marker of Multisystem Cardiopulmonary-Kidney Disease and Mortality in US Adults: : A Nationally Representative Cohort Study.
Level 3 - non-randomized controlled study
Nationally representative cohort study linked to mortality registry data
PubMed 42544354 · doi:10.32481/djph.2026.07.17
What was done
Researchers analyzed data from 14,731 US adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) 2005–2010 linked to the National Death Index through 2019 (14,718 eligible for mortality analyses). Fecal incontinence was defined as accidental leakage of mucus, liquid, or solid stool in the preceding 30 days. Cardiopulmonary-kidney (CPK) burden was measured across three domains: self-reported cardiovascular disease, pulmonary disease (asthma, emphysema, chronic bronchitis), and kidney disease markers (eGFR <60 mL/min/1.73 m², urine albumin-creatinine ratio ≥30 mg/g, or self-report). Modified Poisson regression evaluated CPK outcomes, and Cox proportional hazards models assessed all-cause mortality, adjusting for sociodemographic, cardiometabolic, functional, mood, and urinary factors.
What was found
The weighted prevalence of fecal incontinence was 8.4% (95% CI, 7.8%–9.0%). Adults with fecal incontinence were older (mean age 55.6 vs 46.0 years) and had higher prevalences of urinary incontinence (62.0% vs 32.6%), depressive symptoms (17.4% vs 6.2%), and functional limitations (30.3% vs 13.8%) (all P < .001). After full adjustment, fecal incontinence was associated with kidney disease markers (prevalence ratio [PR], 1.16; 95% CI, 1.02–1.32) and simultaneous involvement of all three CPK systems (PR, 2.38; 95% CI, 1.47–3.86). Over follow-up, 2,395 deaths occurred. Crude mortality was 80.8 per 1,000 person-years among those with both fecal incontinence and multisystem CPK burden, compared to 10.6 in those with neither. In adjusted models, multisystem CPK burden alone (hazard ratio [HR], 1.80; 95% CI, 1.58–2.04) and combined fecal incontinence plus CPK burden (HR, 2.14; 95% CI, 1.66–2.77) predicted mortality, whereas fecal incontinence alone did not (HR, 1.06; 95% CI, 0.87–1.28). With multisystem CPK burden as the reference, the combined group did not show a significant mortality increase (HR, 1.19; 95% CI, 0.92–1.54; P = .18).
Why it matters
Fecal incontinence acts as a practical clinical indicator of severe multisystem cardiopulmonary and kidney disease rather than an independent cause of death. Identifying fecal incontinence should prompt comprehensive systemic evaluations, including kidney function assessment, rather than solely anorectal investigation.
Limits
Fecal incontinence, cardiovascular disease, and pulmonary disease were assessed primarily by self-report. Fecal incontinence was based on a 30-day recall window at baseline, which may miss intermittent symptoms or changes over time. Residual confounding from unmeasured general frailty or severity of illness cannot be ruled out.
Cited by
- supports Approximately 7% of Americans experience fecal incontinence.