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Fecal incontinence in US women: A population-based study

      Objective

      The purpose of this study was to determine the prevalence of fecal incontinence (FI) and associated risk factors in a broad age range of community-dwelling women.

      Study design

      This was a population-based, age-stratified postal survey of 6000 women aged 30 to 90 years enrolled in a large HMO in Washington State. Sample was linked to longitudinal automated medical data. FI was defined as loss of liquid or solid stool at least monthly.

      Results

      The response rate was 64%. The prevalence of FI was 7.2%; prevalence increased notably with age. Women with FI reported significant lifestyle alteration and functional disability. Older age (adjusted odds ratio [OR] 2.11-2.22), major depression (OR 2.73), urinary incontinence (OR 2.32), medical comorbidity (OR 1.76-2.58), and operative vaginal delivery (OR 1.52) were significantly associated with increased odds of FI.

      Conclusion

      In this large report of US community-dwelling women, FI was a prevalent condition. Age, major depression, urinary incontinence, medical illness, and operative vaginal delivery were strongly associated with likelihood of FI.

      Key words

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      References

        • Macmillan A.K.
        • Merrie A.E.
        • Marshall R.J.
        • Parry B.R.
        The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature.
        Dis Colon and Rectum. 2004; 47: 1341-1349
        • Perry S.
        • Shaw C.
        • McGrother C.
        • Mathews R.J.
        • Assassa R.P.
        • Dalosso H.
        • et al.
        Prevalence of fecal incontinence in adults aged 40 years or more living in the community.
        Gut. 2002; 50: 480-484
        • Kalantar J.S.
        • Howell S.
        • Talley N.J.
        Prevalence of faecal incontinence and associated risk factors; an underdiagnosed problem in the Australian community?.
        Med J Aust. 2002; 176: 54-57
        • Fialkow M.F.
        • Melville J.L.
        • Lentz G.
        • Miller E.A.
        • Miller J.
        • Fenner D.
        The functional and psychosocial impact of fecal incontinence on women with and without urinary incontinence.
        Am J Obstet Gynecol. 2003; 189: 127-129
        • Enck P.
        • Bielefeldt K.
        • Rathmann W.
        • Purrmann J.
        • Tschope D.
        • Erckenbrecht J.F.
        Epidemiology of faecal incontinence in selected patient groups.
        Int J Colorectal Dis. 1991; 6: 143-146
        • Nygaard I.E.
        • Rao S.S.
        • Sawson J.D.
        Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study.
        Obstet Gynecol. 1997; 89: 896-901
        • Zetterstrom J.P.
        • Lopez A.
        • Anzen B.
        • Dolk A.
        • Norman M.
        • Mellgren A.
        Anal incontinence after vaginal delivery: a prospective study in primiparous women.
        BJOG. 1999; 106: 324-330
        • Gordon D.
        • Groutz A.
        • Goldman G.
        • Avni A.
        • Wolf Y.
        • Lessing J.B.
        • et al.
        Anal incontinence: prevalence among female patients attending a urogynecologic clinic.
        Neurourol Urodyn. 1999; 18: 199-204
        • Roberts R.O.
        • Jacobson S.J.
        • Reilly W.T.
        • Pemberton J.H.
        • Lieber M.M.
        • Talley N.J.
        Prevalence of combined fecal and urinary incontinence: a community-based study.
        J Am Geriat Soc. 1999; 47: 837-841
        • Drossman D.A.
        • Sandler R.S.
        • Broom C.M.
        • McKee D.C.
        Urgency and fecal soiling in people with bowel dysfunction.
        Dig Dis Sci. 1986; 31: 1221-1225
        • Nelson R.
        • Norton N.
        • Cautley E.
        • Furner S.
        Community-based prevalence of anal incontinence.
        JAMA. 1995; 274: 559-561
        • MacLennan A.H.
        • Taylor A.W.
        • Wilson D.H.
        • Wilson D.
        The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery.
        BJOG. 2000; 107: 1460-1470
        • MacArthur C.
        • Glazener C.M.
        • Wilson P.D.
        • Herbison G.P.
        • Gee H.
        • Lang G.D.
        • et al.
        Obstetric practice and faecal incontinence three months after delivery.
        BJOG. 2001; 108: 678-683
        • Chaliha C.
        • Digesu A.
        • Hutchings A.
        • Soligo M.
        • Khullar V.
        Caesarean section is protective against stress urinary incontinence: an analysis of women with multiple deliveries.
        BJOG. 2004; 111: 754-755
        • Altman D.
        • Zetterstrom J.
        • Lopez A.
        • Pollack J.
        • Nordenstam J.
        • Mellgren A.
        Effect of hysterectomy on bowel function.
        Dis Colon Rectum. 2004; 47: 502-508
        • Jorge J.M.
        • Wexner S.D.
        Etiology and management of fecal incontinence.
        Dis Colon Rectum. 1993; 36: 77-97
        • Vaizey C.J.
        • Carapeti E.
        • Cahill J.A.
        • Kamm A.
        Prospective comparison of faecal incontinence grading systems.
        Gut. 1999; 44: 77-80
        • Sandvik H.
        • Hunskaar S.
        • Seim A.
        • Hermstad R.
        • Vanvik A.
        • Bratt H.
        Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey.
        J Epidemiol Comm Health. 1993; 47: 497-499
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study.
        JAMA. 1999; 282: 1737-1744
        • Fishman P.A.
        • Goodman M.J.
        • Hornbrook M.C.
        • Meenan R.T.
        • Bachman D.J.
        • O'Keeffe Rosetti M.C.
        Risk adjustment using automated ambulatory pharmacy data: the RxRisk model.
        Med Care. 2003; 41: 84-99
        • Chwastiak L.A.
        • Von Korff M.
        Disability in depression and back pain: evaluation of the World Health Organization Disability Assessment Schedule (WHO DAS II) in a primary care setting.
        J Clin Epidemiol. 2003; 56: 507-514
        • Melville J.L.
        • Katon W.
        • Delaney K.
        • Newton K.
        Urinary incontinence in U.S. women: a population-based study.
        Arch Int Med. 2005; 165: 537-542
        • Sultan A.H.
        • Kamm M.A.
        • Bartram C.I.
        • Hudson C.N.
        Anal sphincter disruption during vaginal delivery.
        N Engl J Med. 1993; 329: 1905-1911
        • Fenner D.E.
        • Genberg B.
        • Brahma P.
        • Marek L.
        • DeLancey J.O.L.
        Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States.
        Am J Obstet Gynecol. 2003; 189: 543-549
        • Drossman D.A.
        • Talley N.J.
        • Whitehead W.E.
        • Thompson W.G.
        • Corazziari E.
        Research diagnostic questions for functional gastrointestinal disorders.
        in: Drossman D.A. Corazziari E. Talley N.J. Thompson W.G. Whitehead W.E. Rome II: The functional gastrointestinal disorders: Diagnosis, pathophysiology and treatment: A multinational consensus. 2nd ed. Allen Press, Lawrence, KS2000: 669-688