Fecal Urgency Causes and Risk Factors

Primary Gastrointestinal Causes

Diarrhea is by far the most important independent risk factor for fecal urgency and incontinence (OR=53, 95% CI=6.1–471), representing the dominant cause in community surveys 1, 2, 3
Bile acid malabsorption is common in patients with idiopathic diarrhea and should be considered, particularly after ileal resection (even segments >5 cm) 1, 4
Small intestinal bacterial overgrowth (SIBO) can contribute to urgency through altered motility and diarrhea 4
Inflammatory bowel disease causes anorectal inflammation leading to urgency and is a well-established cause 1, 2, 3
Anorectal inflammation from any cause (proctitis, radiation proctitis) can trigger urgency 1, 2, 3
Rectocele (OR=4.9, 95% CI=1.3–19) is an independent risk factor 2, 3

Cancer treatment complications, including chemotherapy and radiation, cause long-term bowel dysfunction with urgency being the most troublesome symptom for patients 4
Right hemicolectomy causes more diarrhea and urgency than left-sided resections due to loss of the "ileal brake" and dysregulated transit time 4
Terminal ileum resection increases bile acid malabsorption risk 4
Cholecystectomy is an independent risk factor (OR=4.2, 95% CI=1.2–15) 2, 3

Dementia, stroke, spinal cord injury or disease, and Parkinson's disease all cause fecal urgency through neurological dysfunction 1, 2, 3, 5
Peripheral neuropathy, particularly from diabetes, affects bowel control 1, 2, 3
Diabetes mellitus causes urgency through peripheral and autonomic neuropathy (disease burden is an independent risk factor) 1, 2, 3, 5

Opioids paradoxically inhibit intestinal motility and can precipitate urgency in the context of overflow or narcotic bowel syndrome 1, 6, 5
Antipsychotics, especially clozapine and phenotiazines, alter gut motility 5
Calcium channel blockers affect intestinal motility 6, 5

Higher BMI (per unit increase, OR=1.1, 95% CI=1.004–1.1) is an independent risk factor 2, 3
Current smoking (OR=4.7, 95% CI=1.4–15) independently increases risk 2, 3
Stress urinary incontinence (OR=3.1, 95% CI=1.4–6.5) is associated with fecal urgency 2, 3
Advanced age and decreased physical activity increase risk 1, 2, 3
Poorly absorbed sugars (sorbitol, fructose) and excessive caffeine intake should be identified through careful dietary history 1
Excessive alcohol consumption and artificial sweeteners contribute to urgency 4