Patient perspective of bowel urgency and bowel urgency-related accidents in crohn’s disease

Abstract OBJECTIVE This study aimed to explore the Crohn’s disease (CD) patient experience of Bowel Urgency (BU) and BU-related accidents to identify what is most relevant and important to patients. METHODS Patients in the US were eligible to participate in this qualitative study if they were ≥18 years of age, had a diagnosis of moderate to severe CD for ≥6 months and had experienced BU in the last 6 months. Interviews were conducted to explore the signs, symptoms, and impacts related to BU and BU-related accidents. Specifically, patients were asked to describe BU and BU-related accident experiences of CD in their own words. Transcripts were coded and analyzed in ATLAS.ti 9 using a systematic thematic analysis. RESULTS A total of 15 patients participated; majority were female (53%), white (53%), receiving biologic and/or conventional therapy (87%), and mean age of 50 yrs. A majority of patients (80%) experienced BU at least once in the last week and 20% had experienced ≥1 BU-related accident in the last month. The time-sensitive need to use or be near the bathroom, uncertainty of BU, and fear of experiencing an accident were reported as the most bothersome aspects of the BU experience. Patients reported 16 signs and symptoms that co-occur with BU, with abdominal pain (87%), fatigue (87%), and abdominal cramping (53%) being most frequently reported (Table 1). Patients reported 36 BU-related impact concepts across 16 domains (Table 1). Impact domains most frequently reported were adaptive behaviors (93%), household chores (87%), and social activities (87%). Impact concepts most frequently reported were dietary changes (87%) and inability to participate in social activities (87%). Inability to participate in family activities, interrupted work activities, and inability to participate in social activities were reported as the most bothersome impacts to patients. All 15 patients reported ever experiencing BU-related accidents. Patients reported 12 signs and symptoms that co-occur with BU-related accidents, with abdominal pain (67%), fatigue (67%), and abdominal cramping (60%) being most frequently reported (Table 2). Patients reported 44 impacts of BU-related accidents across 16 domains (Table 2). Impact domains most frequently reported were adaptive behaviors (100%) and emotional functioning (87%). Impact concepts most frequently reported were dietary changes (80%) and embarrassment (60%). CONCLUSION This study revealed that the experience of BU and BU-related accidents is bothersome to patients with CD, impactful on their daily lives, and occurs despite the use of biologic and/or conventional therapy.