Even when Crohn’s disease and ulcerative colitis are in remission, fecal urgency can persist, and it’s more common than we realize (it was a hot topic at this year’s Digestive Disease Week).
These sudden “gotta-go” moments can be stressful, disruptive, and embarrassing for patients.
Read on for more information PLUS tips on how to help your IBD patients manage their fecal urgency in the absence of inflammation.
Fecal urgency refers to the sudden, overwhelming need to have a bowel movement. While we expect this symptom during active inflammation, its persistence during remission can catch patients and providers off guard.
Fecal urgency isn’t just an inconvenience, it’s associated with reduced well-being, depression, anxiety, trouble sleeping, abdominal pain, fatigue, and an overall poorer quality of life.
What’s causing this unwelcome symptom to stick around even when inflammation is under control?
There’s no one-size-fits-all answer, but some common culprits include:
- A disrupted gut microbiome
- Overlapping disorders of the gut-brain interaction (e.g. IBS-D)
- Increased intestinal permeability
- Bile acid malabsorption
- Pelvic floor dysfunction
- An overactive gastrocolic reflex
- Rectal hypersensitivity
- Bowel motility changes
With so many moving parts, it’s no wonder that identifying the cause—and solution—can be tricky.
Besides encouraging your patients to speak with their medical team, here are 10 practical tips you can pass along to help your patients feel more in control:
- Smaller, more frequent meals: Large meals are more likely to trigger urgency. However, if urgency occurs with every meal, it may help to experiment with larger, less frequent meals.
- Chew slowly and mindfully: Eating too quickly can worsen symptoms.
- Drink fluids between meals: This helps reduce the total volume in the gut.
- Avoid fried and greasy foods: These are common triggers for fecal urgency.
- Try psyllium husk powder: It can slow down GI transit and bulk up stool, giving patients more control over their bowel movements.
- Limit high-roughage foods: Examples include popcorn, nuts, and raw vegetables.
- Beware of sugar alcohols: Found in sugar-free gum, candy, and some fruits and vegetables, they’ve been shown to worsen fecal urgency in people with IBS-D.
- Refer to GI behavioral therapy: Managing stress and anxiety can reduce symptom severity.
- Refer to a pelvic floor specialist: If pelvic floor dysfunction is contributing to urgency, therapy may help.
- Ask the MD about bile acid binders: If bile acid malabsorption is suspected, these can be a game-changer.
As always, use your clinical judgment to determine which of these tips might work best for each patient.
Personalizing recommendations can help them regain control and reduce the stress, anxiety, and other symptoms associated with fecal urgency.
