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Are You Asking About Bowel Urgency?

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Doctor looking on at woman on metro concerned about bowel urgency

Hypothetical patient

Greater than 80% of patients with ulcerative colitis (UC) surveyed reported experiencing bowel urgency during the course of their disease.1,2

Urgency and urgency-related accidents can be difficult for patients to talk about. Some patients with UC may suffer from bowel urgency and bowel urgency accidents in silence.3-5*

*Studies were conducted in Japan (n=501), Poland (n=71), and the United States (n=27).

A recent study found that roughly 30% of patients with UC did not bring up bowel urgency accidents with their doctor because they were too embarrassed.4†

†Based on a Japanese survey study (n=124)

The American College of Gastroenterology (ACG) Has Recently Recognized Urgency as a Distinct Symptom6

The ACG guidelines for symptomatic remission require the control of three key symptoms6:

No bowel urgency icon

BOWEL URGENCY

Stool frequency icon

STOOL FREQUENCY

Rectal bleeding icon

RECTAL BLEEDING

Despite being a primary symptom of UC according to the ACG, the control of urgency is not currently included as an end point for clinical remission in clinical studies.6,7



One survey found that bowel urgency and rectal bleeding were two UC-related symptoms patients would most like to improve.8‡

‡Prospective, observational, anonymous study conducted in Spain in 117 outpatients with Crohn’s disease (n=64) or UC (n=53).

A Conversation About Bowel Urgency Could Be an Essential Step Toward Controlling Their UC Symptoms3,4,6

Jump-start your urgency conversations with these three questions:

  1. Do you experience bowel urgency, or do you ever fear not being able to reach the toilet in time?
    • Understand if your patient is experiencing urgency
  2. Have you had an accident as a result of bowel urgency? If so, when was the last time this happened?
    • Learn if your patient's urgency has resulted in an accident
  3. How does urgency and the fear of not making it to the toilet in time impact your daily life?
    • Understand how bowel urgency impacts your patient’s life and how they cope with it

Sara’s Story: How UC Affected Her Career

Hypothetical ulcerative colitis patient Sara concerned about bowel urgency

Hypothetical patient

Sara is a 28-year-old professional living in Chicago. She was diagnosed with UC 7 years ago and is currently on her first biologic. While traveling to work, Sara had a bowel urgency accident on the commuter train. She wasn’t able to make it in to the office and was too embarrassed to explain what happened. Even though she loves what she does, the fear and panic of another accident was starting to get in the way of her work, and her employer doesn’t allow remote work. Sara felt like she was out of options and decided to switch jobs so that she could work from home.

Sara has struggled off and on with urgency since her UC diagnosis but never felt comfortable talking to her gastroenterologist about it. She copes by changing her life to accommodate the demands of her urgency and her other symptoms. Since her accident on the train, Sara has not only changed jobs so that she doesn’t have to commute, but she also often says “no” to invitations, avoids public spaces, and sees her friends less.

Not All Patients Use the Same Language to Describe Urgency9§

While some patients may stay silent about urgency, others may bring it up in indirect ways.3,4,9|| Patients may describe how they cope with urgency in their day-to-day life without stating the symptom directly.9§

§Based on a qualitative IBD study in the UK (n=611, UC n=302).
||Based on studies conducted in multiple countries.

Know what words and behaviors to look out for.

URGENCY CODE WORDS AND BEHAVIORS

Commit to asking your patients about urgency at every visit.
Get tips for your next patient conversation.

LEARN MORE

Discover the true impact of bowel urgency.

LEARN WHY

References:

  1. Nóbrega VG, Silva INN, Brito BS, Silva J, Silva MCMD, Santana GO. The onset of clinical manifestations in inflammatory bowel disease patients. Arq Gastroenterol. 2018;55(3):290-295. doi:10.1590/S0004-2803.201800000-73
  2. Dulai PS, Jairath V, Khanna R, et al. Development of the symptoms and impacts questionnaire for Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther. 2020;51(11):1047-1066. doi:10.1111/apt.15726
  3. Petryszyn PW, Paradowski L. Stool patterns and symptoms of disordered anorectal function in patients with inflammatory bowel diseases. Adv Clin Exp Med. 2018;27(6):813-818. doi:10.17219/acem/68986
  4. Hibi T, Ishibashi T, Ikenoue Y, Yoshihara R, Nihei A, Kobayashi T. Ulcerative colitis: disease burden, impact on daily life, and reluctance to consult medical professionals: results from a Japanese internet survey. Inflamm Intest Dis. 2020;5:27-35. doi:10.1159/000505092
  5. Devlen J, Beusterien K, Yen L, Ahmed A, Cheifetz AS, Moss AC. The burden of inflammatory bowel disease: a patient-reported qualitative analysis and development of a conceptual model. Inflamm Bowel Dis. 2014;20(3):545-552. doi:10.1097/01.MIB.0000440983.8665 9.81
  6. Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019;114(3):384-413. doi:10.14309/ajg.0000000000000152
  7. U.S. Food and Drug Administration. Ulcerative colitis: clinical trial endpoints guidance for industry. Draft guidance. August 2016. Accessed August 21, 2021. https://www.fda.gov/media/99526/download
  8. Casellas F, Herrera-de Guise C, Robles V, Navarro E, Borruel N. Patient preferences for inflammatory bowel disease treatment objectives. Dig Liver Dis. 2017;49(2):152-156. doi:/10.1016/j.dld.2016.09.009
  9. Dibley L, Norton C. Experiences of fecal incontinence in people with inflammatory bowel disease: self-reported experiences among a community sample. Inflamm Bowel Dis. 2013;19(7):1450-1462. doi:10.1097/MIB.0b013e318281327f