Supplementation with dietary fiber improves fecal incontinence

Background: Human studies have shown that dietary fiber affects stool compo sition and consistency. Because fecal incontinence has been shown to be exa cerbated by liquid stools or diarrhea, management strategies that make stoo l consistency less loose or liquid may be useful. Objective: To compare the effects of a fiber supplement containing psyllium , gum arabic, or a placebo in community-living adults who were incontinent of loose or liquid stools. Mechanisms underlying these effects (e.g., ferme ntation of the fibers and water-holding capacity of stools) were examined. Methods: Thirty-nine persons with fecal incontinence of loose or liquid sto ols prospectively recorded diet intake and stool characteristics and collec ted their stools for 8 days prior to and at the end of a 31-day fiber suppl ementation period. During the fiber supplementation period, they ingested p syllium, gum arabic, or a placebo by random assignment. Results: In the baseline period, the groups were comparable on all variable s measured. In the fiber supplementation period, (a) the proportion of inco ntinent stools of the groups ingesting the fiber supplements was less than half that of the group ingesting the placebo, (b) the placebo group had the greatest percentage of stools that were loose/unformed or liquid, and (c) the psyllium group had the highest water-holding capacity of water-insolubl e solids and total water-holding capacity. The supplements of dietary fiber appeared to be completely fermented by the subjects as indicated by nonsig nificant differences in total fiber, short chain fatty acids and pH in stoo ls among the groups in the baseline or fiber supplementation periods. Conclusions: Supplementation with dietary fiber from psyllium or gum arabic was associated with a decrease in the percentage of incontinent stools and an improvement of stool consistency. Improvements in fecal incontinence or stool consistency did not appear to be related to unfermented dietary fibe r.