Stroke patients are prone to gastrointestinal dysfunction, with a significantly higher risk of fecal incontinence (FI), which severely affects their quality of life.
Aims:
We investigated the incidence and associated risk factors of FI in stroke patients.
Summary of review:
Stroke patients who met the inclusion and exclusion criteria were consecutively recruited at one university medical center from January 2022 to December 2024. FI occurred in 220 of 1359 stroke patients (16.19%). Logistic regression analysis revealed that age, gender, cognitive impairment, National Institutes of Health Stroke Scale (NIHSS) admission score, antibiotic use, and gavage feeding were closely associated with FI incidence in stroke patients. Subsequently, a systematic review and meta-analysis of observational studies followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies were included if they reported the incidence or risk factors of FI in stroke patients. Subgroup analyses were conducted according to the stage of stroke and survey site. The forest plot showed that the incidence of post-stroke FI was 24.42% (95% confidence interval (CI) = 15.11–33.72). On subgroup analysis, the incidence of FI was 25.73% (95% CI = 14.61–36.86) in the acute stage and 15.99% (95% CI = 9.32–22.67) in the rehabilitation stage. Meanwhile, the incidence of FI in the hospital-based stroke patients was 25.31% (95% CI = 11.37–39.26), which was higher than that in the community-dwelling stroke patients (15.14%, 95% CI = 2.26–28.02).
Conclusion:
The incidence of post-stroke FI is relatively high. Age, gender, cognitive impairment, NIHSS score, antibiotic use, and gavage feeding are closely associated with FI occurrence in stroke patients.
MartinezRMuñoz-VenturelliPOrdunezP, et al. Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021. Lancet Reg Health Am2025; 43: 101017.
2.
KatanMLuftA.Global burden of stroke. Semin Neurol2018; 38: 208–211.
3.
SongDXuDZhangK, et al. Stroke mortality risk factors: global trends and regional variations (1990-2021). J Am Heart Assoc2025; 14: e042107.
4.
GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet2018; 392: 1859–1922.
5.
OzkanHAmblerGEsmailTBanerjeeGSimisterRJWerringDJ.Prevalence, trajectory, and factors associated with patient-reported nonmotor outcomes after stroke: a systematic review and meta-analysis. JAMA Netw Open2025; 8: e2457447.
6.
TuzAAHasenbergAHermannDMGunzerMSinghV.Ischemic stroke and concomitant gastrointestinal complications—a fatal combination for patient recovery. Front Immunol2022; 13: 1037330.
7.
MaSFanXHeYLiCQuDManY.Effectiveness and safety of digital rectal stimulation and abdominal massage for neurogenic bowel dysfunction in stroke patients: a randomized controlled trial protocol. Trials2023; 24: 633.
8.
ToddCLJohnsonEEStewartF, et al. Conservative, physical and surgical interventions for managing faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev2024; 10: CD002115.
9.
ZhangYYangHHouSXiaYWangY-Q.Influence of the brain-gut axis on neuroinflammation in cerebral ischemia-reperfusion injury (Review). Int J Mol Med2024; 53: 30.
10.
DinanTGCryanJF.The Microbiome-gut-brain axis in health and disease. Gastroenterol Clin North Am2017; 46: 77–89.
11.
AryaAKHuB.Brain-gut axis after stroke. Brain Circ2018; 4: 165–173.
12.
XuJLuY.The microbiota-gut-brain axis and central nervous system diseases: from mechanisms of pathogenesis to therapeutic strategies. Front Microbiol2025; 16: 1583562.
13.
ArnethB.Gut-brain axis and brain microbiome interactions from a medical perspective. Brain Sci2025; 15: 167.
14.
Camara-LemarroyCRIbarra-YruegasBEGongora-RiveraF.Gastrointestinal complications after ischemic stroke. J Neurol Sci2014; 346: 20–25.
15.
CoggraveMNortonCCodyJD.Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev2014; 2014: CD002115.
16.
MunnZMoolaSLisyK, et al. Chapter 5: systematic reviews of prevalence and incidence. In: AromatarisEMunnZ (eds) JBI manual for evidence synthesis. Adelaide: Joanna Briggs Institute, 2020, pp.177–217.
17.
TivadarMPopitSLocatelliIStuhecM.Critical appraisal of studies evaluating prevalence of attention deficit hyperactivity disorder. Front Psychiatry2025; 16: 1646618.
18.
CruzEWellsYMillerCLanninNACloudGC.Incidence of and risk factors for new-onset urinary and fecal incontinence after acute stroke. Continence2024; 9: 101067.
19.
LucenteGCorralJRodríguez-EsparragozaL, et al. Current incidence and risk factors of fecal incontinence after acute stroke affecting functionally independent people. Front Neurol2021; 12: 755432.
20.
PérezLMInzitariMRoquéM, et al. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia. Neurol Sci2015; 36: 1875–1880.
21.
EnglerTMDouradoCCAmâncioTGFarageLde MelloPAPadulaMPC. Stroke: bowel dysfunction in patients admitted for rehabilitation. Open Nurs J2014; 8: 43–47.
22.
KovindhaAWattanapanPDejprathamPPermsirivanichWKuptniratsaikulV.Prevalence of incontinence in patients after stroke during rehabilitation: a multi-centre study. J Rehabil Med2009; 41: 489–491.
23.
BracciFBadialiDPezzottiP, et al. Chronic constipation in hemiplegic patients. World J Gastroenterol2007; 13: 3967–3972.
24.
OtegbayoJATalabiOAAkereAOwolabiMOOwolabiLFOguntoyeOO.Gastrointestinal complications in stroke survivors. Trop Gastroenterol2006; 27: 127–130.
25.
BrittainKPerrySShawCMatthewsRJaggerCPotterJ.Isolated urinary, fecal, and double incontinence: prevalence and degree of soiling in stroke survivors. J Am Geriatr Soc2006; 54: 1915–1919.
26.
BaztanJJDomenechJRGonzalezM.New-onset fecal incontinence after stroke: risk factor or consequence of poor outcomes after rehabilitation?Stroke2003; 34: e101–102.
27.
HarariDCoshallCRuddAGWolfeCDA. New-onset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact. Stroke2003; 34: 144–150.
28.
NakayamaHJørgensenHSPedersenPMRaaschouHOOlsenTS.Prevalence and risk factors of incontinence after stroke. The Copenhagen Stroke Study. Stroke1997; 28: 58–62.
29.
WadeDTHewerRL.Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry1987; 50: 177–182.
30.
BrocklehurstJCAndrewsKRichardsBLaycockPJ.Incidence and correlates of incontinence in stroke patients. J Am Geriatr Soc1985; 33: 540–542.
31.
ShogenjiMYoshidaMSumiyaK, et al. Relationship between bowel/bladder function and discharge in older stroke patients in convalescent rehabilitation wards: a retrospective cohort study. Prog Rehabil Med2022; 7: 20220028.
32.
ChohanSAVenkateshPKHowCH.Long-term complications of stroke and secondary prevention: an overview for primary care physicians. Singapore Med J2019; 60: 616–620.
33.
GyrikiDNikolaidisCGBezirtzoglouEVoidarouCStavropoulouETsigalouC.The gut microbiota and aging: interactions, implications, and interventions. Front Aging2025; 6: 1452917.
34.
Borrego-RuizABorregoJJ.Influence of human gut microbiome on the healthy and the neurodegenerative aging. Exp Gerontol2024; 194: 112497.
35.
SchellLDCarmodyRN.An energetic framework for gut microbiome-mediated obesity induced by early-life exposure to antibiotics. Cell Host Microbe2025; 33: 470–483.
36.
KesterJCBrubakerDKVelazquezJWrightCLauffenburgerDAGriffithLG.Clostridioides difficile-associated antibiotics alter human mucosal barrier functions by microbiome-independent mechanisms. Antimicrob Agents Chemother2020; 64: e01404-19.
37.
QianMWangJJiX, et al. Sub-chronic exposure to antibiotics doxycycline, oxytetracycline or florfenicol impacts gut barrier and induces gut microbiota dysbiosis in adult zebrafish (Daino rerio). Ecotoxicol Environ Saf2021; 221: 112464.
38.
KrishnanMYeapSHowellB, et al. Improving safety and timeliness around nasogastric tube feeding on an acute stroke unit. BMJ Open Qual2025; 14: e003353.
39.
HallEHansenBPihlsgardM, et al. The impact of comorbidity burden on outcomes following endovascular thrombectomy for acute ischemic stroke: a nationwide prospective observational study. Eur Stroke J2026; 11: 23969873251332136.
40.
PadwaleVChivateCKirnakeVPatilHKumarSPantbalekundriN.Comparative prognostic value of the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS) in supratentorial and infratentorial stroke patients in western India. Cureus2024; 16: e65778.
41.
WangYCChangPFChenYM, et al. Comparison of responsiveness of the Barthel Index and modified Barthel Index in patients with stroke. Disabil Rehabil2023; 45: 1097–1102.
42.
YangJXHanYJYangMMGaoC-HCaoJ.Risk factors and predictors of acute gastrointestinal injury in stroke patients. Clin Neurol Neurosurg2023; 225: 107566.
43.
PacinellaGCiaccioAMTuttolomondoA.Molecular links and clinical effects of inflammation and metabolic background on ischemic stroke: an update review. J Clin Med2024; 13: 7515.
44.
MaoFLHeXHuangXLChengY-MQinF-LWangY-Q.Predictive value of lymphocyte-associated inflammation index in post-stroke cognitive impairment: a systematic review and meta-analysis. Front Neurol2025; 15: 1469152.
45.
HuangYWZhangYFengCAnY-HLiZ-PYinX-S.Systemic inflammation response index as a clinical outcome evaluating tool and prognostic indicator for hospitalized stroke patients: a systematic review and meta-analysis. Eur J Med Res2023; 28: 474.
46.
LiSJingJLiJWangAMengXWangY.Elevated hs-CRP and symptomatic intracranial/extracranial artery stenosis predict stroke recurrence after acute ischemic stroke or TIA. J Atheroscler Thromb2023; 30: 601–610.
47.
EbrahimiRKalantariTSarkariF, et al. Serum levels of inflammatory markers, sP-selectin, IL-1β, IL-6, and hsCRP are positively correlated with tissue factor transcript level of peripheral blood mononuclear cells in stroke. Blood Coagul Fibrinolysis2025; 36: 180–190.
48.
QiYShangXHanT, et al. Serum cystatin C and stroke risk: a national cohort and Mendelian randomization study. Front Endocrinol (Lausanne)2024; 15: 1355948.
49.
ZhaoMDaiZLiuRLiuXXuG.Post-procedural plasma D-dimer level may predict futile recanalization in stroke patients with endovascular treatment. J Stroke Cerebrovasc Dis2025; 34: 108248.
50.
LiJChenSYangS, et al. Hypercoagulable state and gut microbiota dysbiosis as predictors of poor functional outcomes in acute ischemic stroke patients. mSystems2025; 10: e0149224.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
