Dietary Fiber Supplementation for Fecal Incontinence: A Randomized Clinical Trial

Abstract

Dietary fiber supplements are used to manage fecal incontinence (FI), but little is known about the fiber type to recommend or the level of effectiveness of such supplements, which appear related to the fermentability of the fiber. The aim of this single-blind, randomized controlled trial was to compare the effects of three dietary fiber supplements (carboxymethylcellulose [CMC], gum arabic [GA], or psyllium) with differing levels of fermentability to a placebo in community-living individuals incontinent of loose/liquid feces. The primary outcome was FI frequency; secondary outcomes included FI amount and consistency, supplement intolerance, and quality of life (QoL). Possible mechanisms underlying supplement effects were also examined. After a 14-day baseline, 189 subjects consumed a placebo or 16g total fiber/day of one of the fiber supplements for 32 days. FI frequency significantly decreased after psyllium supplementation versus placebo, in both intent-to-treat and per-protocol mixed model analyses. CMC increased FI frequency. In intent-to-treat analysis, the number of FI episodes/week after supplementation was estimated to be 5.5 for Placebo, 2.5 for Psyllium, 4.3 for GA, and 6.2 for CMC. Only psyllium consumption resulted in a gel in feces. Supplement intolerance was low. QoL scores did not differ among groups. Patients with FI may experience a reduction in FI frequency after psyllium supplementation, and decreased FI frequency has been shown to be an important personal goal of treatment for patients with FI. Formation of a gel in feces appears to be a mechanism by which residual psyllium improved FI.

The Role of Legumes in Human Nutrition

“…In addition, dietary fibre, particularly soluble dietary fibre, has the ability to lower blood cholesterol, improve glucose tolerance and reduce glycaemic response by forming a protective gel lining along the intestinal walls thus reducing glucose and cholesterol assimilation into the bloodstream [22,24,25]. Insoluble dietary fibres are porous, have low densities, increase faecal bulk and promote normal laxation [26][27][28]. As such, legumes are an invaluable component of the human diet.…”

Alternativa Eficaz al Tratamiento Farmacológico sobre el Estreñimiento en Ancianos Institucionalizados: Estudio Libera

“…En este sentido, se ha puesto de manifiesto que los beneficios asociados al consumo de fibra están relacionados con la composición de la fibra concreta que estemos administrando, como el grado de fermentación y la viscosidad de la fibra al ser hidratada 23,24 . De forma que los efectos beneficiosos en caso de estreñimiento se darían en fibras poco fermentables y viscosas, al aumentar en mayor grado la masa fecal debido a los restos de fibra no digeridos y a su capacidad para retener agua 25 .…”

“…También es importante remarcar que dependiendo de la edad, del estado nutricional y del nivel de actividad de los pacientes incluidos en cada estudio, los productos alimenticios o complementos de fibra tendrán un impacto diferente. Por lo tanto, es coherente que la administración de fibra dietética en estudios con población geriátrica se asocie con mayores beneficios 11,17,18 que en población infantil o adulta [22][23][24] . En este sentido, nuestro estudio identifica que la administración del postre rico en fibra y sorbitol se asocia a una mayor reducción en el uso de laxantes en pacientes mayores y ayuda a combatir el estreñimiento.…”

Evidence-Based Update on Treatments of Fecal Incontinence in Women

“…Increasing rectal distension can improve sensory awareness of the need to defecate which may reduce FI episodes and promote complete evacuation of stool, leaving less in the rectum to leak. [11,14,15] Compared to constipation, data on the effects of fiber supplementation on FI are limited, and most studies are not adequately powered.…”

“…In addition, a gel formation was found only in the feces of the psyllium group, maintaining stool consistency. [14]…”