Digital Gut-Directed CBT May Improve Fecal Incontinence in IBS

Introduction Fecal incontinence (FI) occurs in up to 20% of irritable bowel syndrome (IBS) patients, with a negative impact on quality of life, psychologic symptoms, and work impairment. We aimed to evaluate the impact of an app-based gut-directed cognitive behavioral therapy (CBT) program on IBS-associated fecal incontinence (FI) using real-world evidence from user data. Methods The study population was selected from 1,383 Mahana (TM) IBS users who had completed a 3-month access period for a prescription CBT program between August 2021 and February 2024. Patients completed at least one of the 10-session program, completed >= 2 symptom log entries, reported >= 1 FI episode during the program, and completed assessments of symptom severity (IBS Symptom Severity Scoring System; IBS-SSS). Mixed-effects linear regression models analyzed the number of FI episodes/user during each session and changes in IBS-SSS as a function of session progression. Results Sixty-six patients met inclusion criteria with mean age of 49 +/- 18 years and a baseline IBS-SSS of 286 +/- SD 104. IBS-SSS decreased to 206 +/- 125 and 193 +/- 129 at sessions 5 and 10, respectively (p < 0.0001). Mean FI episodes/user decreased from 5 +/- 11 in session 1 to 0.5 +/- 1.5 and 0.1 +/- 0.3 in sessions 5 and 10, respectively (p < 0.0001). Responder analysis found that 100% of patients who completed 2 + sessions met the criteria of >= 50% reduction in FI episodes between their first and last session. Discussion Our findings suggest that gut-directed digital CBT may reduce the frequency of IBS-associated FI. Future studies should evaluate how brain-gut behavioral therapies can affect anorectal mechanosensory phenomena.