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Title: Symptoms associated with dietary fiber supplementation over time in individuals with fecal incontinence

item BLISS, DONNA - University Of Minnesota
item SAVIK, KAY - University Of Minnesota
item Jung, Hans Joachim
item WHITEBIRD, ROBIN - University Of Minnesota
item LOWRY, ANN - University Of Minnesota

Submitted to: Nursing Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/27/2010
Publication Date: 5/1/2011
Citation: Bliss, D.Z., Savik, K., Jung, H.G., Whitebird, R., Lowry, A. 2011. Symptoms associated with dietary fiber supplementation over time in individuals with fecal incontinence. Nursing Research. 60(3S):S58-S67.

Interpretive Summary: Fecal incontinence is a condition that impacts a significant proportion of the U.S population and is particularly prevalent in the elderly. Supplementation with various sources of dietary fiber has shown promise in managing this condition; however, all medical dietary fiber interventions suffer from patient withdrawal from therapy due to flatulence, feelings of abdominal bloating, and other symptoms that cause distress. As part of a study examining the mechanism by which dietary fiber alleviates fecal incontinence severity, a time-course study of the progression of negative symptoms from dietary fiber therapy was conducted. Results indicated that while most patients experienced only minimal severity symptoms associated with supplementation with dietary fiber, approximately 10% of patients chose to withdraw from the study due to negative symptoms from dietary fiber supplementation. Those individuals who withdrew tended to have symptoms that increased in severity the longer they remained on the fiber supplement. These results suggest that while dietary fiber supplementation is tolerated by most patients, a subset of patients can be expected to suffer negative symptoms that cause them to withdraw from treatment. Scientists and clinicians using dietary fiber medical therapies will benefit from this research as guidance to possible patient outcomes when consuming fiber supplements.

Technical Abstract: The purpose of this study was to compare the severity of adverse gastrointestinal (GI) symptoms during supplementation with dietary fiber or placebo over time in adults with fecal incontinence. Secondary aims were to determine the relationship between symptom severity and upset and their association with study attrition and reduction of fiber dose. Subjects (N=189) with fecal incontinence were randomly assigned to placebo or a supplement of 16 g total dietary fiber/d of one of three fiber sources; gum arabic, psyllium, or carboxymethylcellulose. They reported severity of GI symptoms daily during baseline (14 d), incremental fiber dosing (6d), and two segments of steady full dose of fiber (32 d total). Median severity of symptoms in all groups was minimal. Adjusting for study segment and day, a greater feeling of fullness in the psyllium group was the only symptom that differed from symptoms in the placebo control group. The odds of having larger amounts of flatus, belching, fullness, and bloating were 1.7 to 1.9 times greater in the two steady dose segments compared to baseline. There was a positive association between the severity of symptoms and emotional upset about symptoms. Subjects with a greater feeling of fullness or bloating or greater score for total symptom severity or upset were more likely to withdraw from the study or reduce fiber dose. Fiber supplements seemed well tolerated. Persons with fecal incontinence experience a variety of GI symptoms over time. Symptom severity and upset appear to influence fiber tolerance and study attrition.