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Outcomes of combination treatment of fecal incontinence in women

  • Alayne D. Markland
    Correspondence
    Reprints: Alayne D. Markland, DO, MSc, VA Medical Center, GRECC/11G, 700 19th St. S., Birmingham, AL 35233
    Affiliations
    Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL

    Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Birmingham, AL
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  • Holly E. Richter
    Affiliations
    Division of Women's Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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  • Kathryn L. Burgio
    Affiliations
    Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL

    Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Birmingham, AL
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  • Thomas L. Wheeler II
    Affiliations
    Division of Women's Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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  • David T. Redden
    Affiliations
    Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Birmingham, AL

    University of Alabama at Birmingham School of Public Health, Birmingham, AL
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  • Patricia S. Goode
    Affiliations
    Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL

    Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Birmingham, AL
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      Objective

      To describe how women with fecal incontinence (FI) respond to combined pharmacologic therapy and pelvic floor muscle exercises (PFME).

      Study Design

      Validated questionnaires (Fecal Incontinence Severity Index and Modified Manchester Health Questionnaire) were mailed to 80 women who received combined therapy for FI and had complete baseline assessments. Regression models were constructed to identify predictors of change in questionnaire scores.

      Results

      Response rate was 69%. Mean age was 59 ± 12 years. All women were taught PFME with digital palpation, and 87% of the women received medications. FI severity scores and quality-of-life (QOL) improved from baseline to follow-up (P < .001 and P = .02, respectively). A fair/normal external anal sphincter (EAS) contraction resulted in greater improvements in FI severity (13 points, P = .006) and QOL scores (22 points, P < .001).

      Conclusion

      FI severity and QOL improved after combination therapies, and a fair/normal EAS contraction predicted greater improvement.

      Key words

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      References

        • Norton C.
        • Whitehead W.E.
        • Bliss D.Z.
        • Metsole P.
        • Tries J.
        Conservative and pharmacologic management of fecal incontinence in adults.
        in: Abrams P. Cardozo L. Khoury S. Wein A. Incontinence, 3rd International Consultation on Incontinence. Health Publications Ltd, Paris, France2005: 1521-1564
        • Melville J.L.
        • Fan M.Y.
        • Newton K.
        • Fenner D.
        Fecal incontinence in US women: a population-based study.
        Am J Obstet Gynecol. 2005; 193: 2071-2076
        • Goode P.S.
        • Burgio K.L.
        • Halli A.D.
        • et al.
        Prevalence and correlates of fecal incontinence in community-dwelling older adults.
        J Am Geriatr Soc. 2005; 53: 629-635
        • Varma M.
        • Brown J.S.
        • Creasman J.M.
        • et al.
        Fecal incontinence in females older than aged 40 years: who is at risk?.
        Dis Colon Rectum. 2006; 49: 841-851
        • Bharucha A.E.
        • Zinsmeister A.R.
        • Locke G.R.
        • Schleck C.
        • McKeon K.
        • Melton L.J.
        Symptoms and quality of life in community women with fecal incontinence.
        Clin Gastroenterol Hepatol. 2006; 4: 1004-1009
        • Macmillan A.K.
        • Merrie A.E.H.
        • Marshall R.J.
        • Parry B.R.
        The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature.
        Dis Colon Rectum. 2004; 47: 1341
        • Sailer M.
        • Bussen D.
        • Debus E.S.
        • Fuchs K.H.
        • Thiede A.
        Quality of life in patients with benign anorectal disorders.
        Br J Surg. 1998; 85: 1716-1719
        • Norton C.
        • Chelvanayagam S.
        • Wilson-Barnett J.
        • Redfern S.
        • Kamm M.A.
        Randomized controlled trial of biofeedback for fecal incontinence.
        Gastroenterology. 2003; 125: 1320-1329
        • Boreham M.K.
        • Richter H.E.
        • Kenton K.S.
        • et al.
        Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of life.
        Am J Obstet Gynecol. 2005; 192: 1637-1642
        • Cheetham M.
        • Brazzelli M.
        • Norton C.
        • Glazener C.M.
        Drug treatment for faecal incontinence in adults.
        Cochrane Database of Systematic Reviews. 2003; (CD002116)
        • Trowbridge E.R.
        • Morgan D.
        • Trowbridge M.J.
        • Delancey J.O.L.
        • Fenner D.E.
        Sexual function, quality of life, and severity of anal incontinence after anal sphincteroplasty.
        Am J Obstet Gynecol. 2006; 195: 1753
        • Kwon S.
        • Visco A.G.
        • Fitzgerald M.P.
        • Ye W.
        • Whitehead W.E.
        • Pelvic Floor Disorders Network
        Validity and reliability of the Modified Manchester Health Questionnaire in assessing patients with fecal incontinence.
        Dis Colon Rectum. 2005; 48: 323-331
        • Herzog A.R.
        • Diokno A.C.
        • Brown M.B.
        • Normolle D.P.
        • Brock B.M.
        Two year incidence, remission, and change in patterns of urinary incontinence in non institutionalized older adults.
        J Gerontol. 1990; 45: M67-M74
        • Brink C.A.
        • Wells T.J.
        • Sampselle C.M.
        • Taillie E.R.
        • Mayer R.
        A digital test for pelvic muscle strength in women with urinary incontinence.
        Nurs Res. 1994; 43: 352-356
        • Remes-Troche J.
        • Ozturk R.
        • Philips C.
        • Stessman M.
        • Rao S.
        Cholestyramine—a useful adjunct for the treatment of patients with fecal incontinence.
        Int J Colorectal Dis. 2008; 23: 189
        • Burgio K.L.
        • Goode P.S.
        • Richter H.E.
        • Locher J.L.
        • Roth D.L.
        Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings.
        Neurourol Urodyn. 2006; 25: 411-417
        • Avery K.N.
        • Bosch J.L.
        • Gotoh M.
        • et al.
        Questionnaires to assess urinary and anal incontinence: review and recommendations.
        J Urol. 2007; 177: 39-49
        • Rockwood T.H.
        • Church J.M.
        • Fleshman J.W.
        • et al.
        Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index.
        Dis Colon Rectum. 1999; 42: 1525-1532
        • Bharucha A.E.
        • Locke G.R.
        • Seide B.M.
        • Zinsmeister A.R.
        A new questionnaire for constipation and faecal incontinence.
        Aliment Pharmacol Ther. 2004; 20: 355-364
        • Norton C.
        • Kamm M.A.
        Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults—a systematic review.
        Aliment Pharmacol Ther. 2001; 15: 1147-1154
        • Wald A.
        Fecal incontinence in adults.
        N Engl J Med. 2007; 356: 1648-1655
        • Fox J.
        • Fletcher J.
        • Zinsmeister A.
        • Seide B.
        • Riederer S.
        • Bharucha A.
        Effect of aging on anorectal and pelvic floor functions in females.
        Dis Colon Rectum. 2006; 49: 1726
        • Bharucha A.E.
        Pro: anorectal testing is useful in fecal incontinence.
        Am J Gastroenterol. 2006; 101: 2679-2681
        • Wald A.
        Con: anorectal manometry and imaging are not necessary in patients with fecal incontinence.
        Am J Gastroenterol. 2006; 101: 2681-2683
        • Richter H.E.
        • Fielding J.R.
        • Bradley C.S.
        • et al.
        Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears.
        Obstet Gynecol. 2006; 108: 1394-1401
        • Rhona M.
        • Michael B.
        • Leslie D.
        • Catriona K.
        • Colm O.H.
        • Connell P.R.O.
        Internal anal sphincter defect influences continence outcome following obstetric anal sphincter injury.
        Am J Obstet Gynecol. 2007; 196: 217.e1
        • Wheeler II, T.L.
        • Richter H.E.
        Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem.
        Curr Opin Obstet Gynecol. 2007; 19: 474-479
        • Rao S.S.
        • American College of Gastroenterology Practice Parameters Committee
        Diagnosis and management of fecal incontinence.
        Am J Gastroenterol. 2004; 99: 1585-1604
        • Norton C.
        • Thomas L.
        • Hill J.
        Guideline development: management of faecal incontinence in adults: summary of NICE guidance.
        BMJ. 2007; 334: 1370-1371