Missed Opportunities: A Mixed-Methods Assessment of Disparities in Treatment for Fecal Incontinence. Urogynecology (Phila) 2025 Mar 01;31(3):243-249
Date
12/17/2024Pubmed ID
39689216DOI
10.1097/SPV.0000000000001619Scopus ID
2-s2.0-85212880929 (requires institutional sign-in at Scopus site)Abstract
IMPORTANCE: Previous work identified racial disparities in access to fecal incontinence (FI) treatments. However, less is known about patient perspectives of these barriers.
OBJECTIVES: This study assessed differences in FI symptom severity and treatment utilization between Black and White patients.
STUDY DESIGN: This mixed-methods assessment studied adult non-Hispanic Black and White women treated for FI who either did not respond to medical therapy nor received sacral neuromodulation or did not follow up after medical therapy. Structured interviews queried patients about treatments offered and symptom severity.
RESULTS: Of the 118 patients in the retrospective evaluation, 59 (50%, 24 Black and 35 White) were interviewed. Black patients were more likely than White patients to report occasional, weekly, or daily solid and stool incontinence (75.0% vs 48.6%, P = 0.042; 87.5% vs 51.4%, P = 0.004, respectively) and flatal incontinence (83.3% vs 62.9%, P = 0.088).Of those prescribed fiber supplements and antidiarrheal medications, Black patients were less likely to report symptom improvement (25.0% vs 70.0%, P = 0.013; 57.1% vs 87.5%, P = 0.092, respectively, for each medication type) and ongoing regimen adherence (25.0% vs 63.3%, P = 0.013; 28.6% vs 87.5%, P = 0.035, respectively).Black patients were more likely to report impairment in daily functioning secondary to FI (83.3% vs 57.1%, P = 0.034) and were more likely to seek a follow-up visit with a health care professional that performs sacral neuromodulation (79.2% vs 28.6%, P < 0.001).
CONCLUSIONS: Black patients were more likely to have severe symptoms and poorer treatment outcomes and desire future follow-up, highlighting the importance of addressing racial differences in patient preferences in FI management strategies.
Author List
Seitz V, Calata J, Mei L, Davidson ERWAuthors
Jed Calata MD Assistant Professor in the Surgery department at Medical College of WisconsinEmily Davidson MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Fecal Incontinence
Female
Healthcare Disparities
Humans
Middle Aged
Retrospective Studies
Severity of Illness Index
