Dietary fibre supplementation with psyllium or Acacia (gum arabic) reduced faecal incontinence

Evidence-Based Medicine 2002; 7:20
© 2002 Evidence-Based Medicine

Dietary fibre supplementation with psyllium or Acacia (gum arabic) reduced faecal incontinence in community-living adults
Bliss DZ, Jung HJ, Savik K, et al. Supplementation with dietary fiber improves fecal incontinence. Nurs Res 2001 Jul–Aug;50:203–13

QUESTION: In community-living adults with incontinence of loose or liquid stools, does dietary fibre supplementation with psyllium or gum arabic reduce faecal incontinence?

Design
Randomised {allocation concealed*}, blinded {clinicians, participants, and statisticians},* placebo controlled trial with 8 day post-intervention comparison.

Setting
Colorectal surgical practice and community in Minneapolis, Minnesota, USA.

Participants
42 adults (mean age 61 y) with at least weekly faecal incontinence of loose or liquid stools. Exclusion criteria were rectal prolapse, colon cancer, rectal fistula, ulcerative colitis, or removal of some portion of the gastrointestinal tract. No participant had biofeedback training for pelvic muscle exercises. Follow up was 93%.

Intervention
Participants were allocated to receive 31 days of dietary fibre supplementation with psyllium 7.1 g/day (n=13); gum arabic 25 g/day (n=13); or placebo given as pectin 0.25 g/day (n=13). Supplements were mixed into fruit juice and divided into 2 servings for consumption during the morning and evening meals. Participants were instructed to maintain their usual diet. Those who were taking antidiarrhoeal medication were advised not to alter the type and amount during the study.

Main outcome measures
Daily self reported stool characteristics, including rate of incontinent stools, stool consistency, stool frequency, and stool weight.

Main results
The rates of incontinent stools for the psyllium and gum arabic groups were lower than for the placebo group (table). The psyllium and gum arabic groups had lower rates of loose and unformed or liquid stools than did those in the placebo group (2(6)=20.8, p=0.002). No difference existed between the 3 groups for stool frequency, wet weight of stool, or weight of total stool solids.

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Psyllium, gum arabic, and placebo for faecal incontinence at 8 days

Conclusion
In adults living in the community, dietary fibre supplementation with psyllium or gum arabic reduced the rate of incontinent stools and improved stool consistency.

Footnotes
Sources of funding: National Institute of Nursing Research; National Institutes of Health; American Federation for Aging Research; Sigma Theta Tau Zeta Chapter; University of Minnesota

http://ebm.bmjjournals.com/cgi/content/full/7/1/20

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