Is self-reported recurrent urinary tract infection associated with anal incontinence and obstructive defecation? A multicentre case-control study using electronic PROM data

Aim: The accepted model for the pathogenesis of female urinary tract infection (UTI) is ascending infection with bowel flora from anus to urethra, though anal incontinence (AI) and obstructive defecation (ODS) have not previously been demonstrated to be risk factors for recurrent UTI (rUTI). This study aimed to use patient-reported outcome (PROM) data to investigate the association between AI and ODS with self-reported rUTI in women. 

Method: Data obtained from 7990 completed ePAQ-Pelvic Floor PROMs at seven participating NHS hospitals between 2018 and 2022 were analysed. Essential inclusion criteria were completion of both the bowel dimension and item assessing self-reported rUTI in consenting participants. Participants were divided into cases and controls based on self-reported frequency of UTI. Mann–Whitney, logistic regression and Spearman's rank analyses were performed to assess for associations between self-reported rUTI with AI and ODS. 

Results: rUTI was reported by 931 women (11.7%). Significantly worse symptom scores for flatus incontinence (p < 0.0001) (OR 1.24), liquid AI (p < 0.0001) (OR 1.38), solid AI (p = 0.0031) (OR 1.24), passive faecal incontinence (p < 0.0001) (OR 1.40), use of pads for AI (p < 0.0001) (OR 1.34), perineal splinting/vaginal digitation (p < 0.0001) (OR 1.19) and anal digitation (p < 0.0001) (OR 1.30) were reported in participants with rUTI. Frequency of UTI weakly correlated with all AI and ODS symptoms (r = 0.069–0.151, p < 0.0001). 

Conclusion: AI and ODS symptoms are significantly associated with increased rates of self-reported rUTI in this study, supporting the theory that these conditions may contribute to the pathogenesis of rUTI in women. Whilst the aetiology of rUTI is multifactorial, AI and ODS are contributory risk factors.