Examining racial disparities in counseling about sacral neuromodulation for men and women with idiopathic fecal incontinence

Background Black patients undergo sacral neuromodulation for urinary incontinence less than White patients. There is less known about racial disparities in fecal incontinence. Objective To determine if racial disparities in fecal incontinence care exist, specifically sacral neuromodulation education. Design This was a retrospective cohort study of adults treated for fecal incontinence from 2011 to 2021 at an academic health center. Settings Medical records were queried to collect clinical variables, including diagnostic tests ordered, treatments offered or discussed, and specialties treating the patients' fecal incontinence. Patients The two cohorts were patients who identified as non-Hispanic Black or non-Hispanic White. Main outcome measures The primary outcome was the percent of patients with documentation of discussion of sacral neuromodulation. Results 180 Black patients and 360 age-matched White patients were included. 21.7% of patients with fecal incontinence had documented counseling about sacral neuromodulation which was significantly less frequent in Black patients (12.8% vs 26.1%, p < 0.001). However, among only patients with this counseling documented, there was no difference based on race (17.4% vs 21.3%, p = 0.679). Black patients were also less likely to receive referrals for pelvic floor physical therapy (52.2% vs 72.2%, p < 0.001), anorectal manometry (41.1% vs 51.9%, p = 0.018), sphincter imaging (1.1% vs 5.3%, p = 0.018), and defecography (7.2% vs 16.1%, p = 0.004).Patients seen by Urogynecology, Colorectal Surgery, and/or Urology were more likely to be counseled about sacral neuromodulation (48.4% vs 2.8%, p < 0.001). On multivariate logistic regression, Black race (OR 0.45 95% CI 0.25-0.81), male sex (OR 3.15 95% CI 1.33-7.41), and not seeing a surgical specialist (OR 0.03 95% CI: 0.01-0.06) were associated with no sacral neuromodulation counseling. Limitations Limitations include reliance on chart documentation for the primary outcome. Conclusion Racial differences in treatment of fecal incontinence exist between Black and White patients, including differences in counseling about sacral neuromodulation.