Urgency and Its Association With Quality of Life and Clinical Outcomes in Patients With Ulcerative Colitis

Abstract

INTRODUCTION:Urgency, the immediate need to defecate, is common in active ulcerative colitis (UC). We investigated the association of urgency in patients with UC with (i) quality of life (QoL) domains and (ii) future hospitalizations, corticosteroid use, and colectomy for UC.METHODS:We conducted a cross-sectional and subsequent longitudinal study within Inflammatory Bowel Disease Partners, a patient-powered research network. We described associations of levels of urgency in patients with UC with Patient-Reported Outcomes Measurement Information System QoL domains. We conducted a longitudinal cohort to determine associations between baseline urgency and subsequent hospitalization, corticosteroid use, or colectomy for UC within 12 months. We used bivariate statistics and logistic regression models to describe independent associations.RESULTS:A total of 632 patients with UC were included in the cross-sectional study. After adjusting for clinical variables, rectal bleeding, and stool frequency, urgency defined as “hurry,” “immediately,” and “incontinence” increased the odds of social impairment (odds ratio [OR] 2.05 95% confidence interval [CI] 1.24–3.4, OR 2.76 95% CI 1.1–6.74, and OR 7.7 95% CI 1.66–38.3, respectively) compared with “no hurry.” Urgency also significantly increased the odds of depression, anxiety, and fatigue. Urgency was associated with a significant increase in risk of hospitalizations and corticosteroids, whereas “hurry,” “immediately,” and “incontinence” increased the odds of colectomy within 12 months by 1.42 (1.15–1.75), 1.90 (1.45–2.50), and 3.69 (2.35–5.80).DISCUSSION:We demonstrated that urgency is a patient-reported outcome independently associated with compromised QoL and future risk of hospitalizations, corticosteroids, and colectomy. Our findings support the consideration of urgency as a UC-specific patient-reported outcome and its use as an outcome in clinical trials to capture QoL and risk of clinical decompensation.

Urgency for bowel movements is a highly discriminatory symptom of active disease in persons with IBD (the Manitoba Living with IBD study)

“…Absence of urgency was one of the symptoms to best predict not having disease activity across all three measures in all subgroups and was consistently one of the most discriminatory symptoms based on AUC in predicting disease activity across all three measures irrespective of sex and disease type. Not only did we identify urgency as one of the most prevalent and discriminatory symptoms for active disease, but urgency has also been shown to be the most important symptom to patients, 24 impairs quality of life, increases risk of depression/anxiety and is associated with poor outcomes such as hospitalisation, use of steroids and colectomy 25 . Additionally, not only is urgency a frequent symptom during active disease but has demonstrated responsiveness to therapy 26 .…”

“…Not only did we identify urgency as one of the most prevalent and discriminatory symptoms for active disease, but urgency has also been shown to be the most important symptom to patients, 24 impairs quality of life, increases risk of depression/anxiety and is associated with poor outcomes such as hospitalisation, use of steroids and colectomy. 25 Additionally, not only is urgency a frequent symptom during active disease but has demonstrated responsiveness to therapy. 26 The urgency of bowel movements can therefore be utilised by all clinicians as a routine symptom to review during clinical patient encounters regardless of IBD subtype, and in assessing responsiveness to therapy.…”

“…Fatigue has been demonstrated to be the most burdensome symptom of daily life, 23,30 and affects the quality of life independent of disease activity. 28,31 There is also evidence to suggest urgency increases the odds of developing fatigue, 25 suggesting synergy between these two symptoms, highlighting the importance of addressing both of these symptoms simultaneously during a clinic assessment. 32 Even though fatigue was not a consistently discriminatory symptom for active disease, it remains a burdensome symptom, 23,30,32 adversely impacting quality of life, 28,31,33 work disability, and depression.…”

International Consensus on Definition of Mild-to-Moderate Ulcerative Colitis Disease Activity in Adult Patients

“…They agreed that fecal urgency, stool frequency and rectal bleeding are appropriate in the assessment of mild-to-moderate UC disease activity. Fecal urgency is one of the common and most disabling symptoms that patients with UC experience [ 14 , 15 , 16 , 17 ]. Although fecal urgency is a key symptom for defining severity of disease activity in clinical practice and has a particularly distressing impact on patients, it is not included in the tools currently used to define IBD severity [ 18 ].…”

Clinical Effect of Mirikizumab Treatment on Bowel Urgency in Patients with Moderately to Severely Active Ulcerative Colitis and the Clinical Relevance of Bowel Urgency Improvement for Disease Remission

“…The primary symptoms of ulcerative colitis (UC) include rectal bleeding, increased stool frequency, and bowel movement urgency. 1 Bowel urgency is the sudden or immediate need to have a bowel movement 2,3 and is associated with reduced healthrelated quality of life. [4][5][6] Bowel urgency is common in UC and the symptom patients most want to improve.…”