Anal incontinence in women presenting for gynecologic care: Prevalence, risk factors, and impact upon quality of life
ABSTRACT The purpose of this study was to estimate the prevalence and impact upon quality of life of anal incontinence (AI) in women aged 18 to 65.
Consecutive women presenting for general gynecologic care were given a bowel function questionnaire. Women with AI were prompted to complete the Fecal Incontinence Severity Index (FISI) and Fecal Incontinence Quality of Life Scale (FIQL).
The cohort was composed of 457 women with a mean age of 39.9 +/- 11 years. AI prevalence was 28.4% (95% CI 24.4-32.8). After logistic regression, IBS (OR 3.22, 1.75-5.93), constipation (OR 2.11, 1.22-3.63), age (OR 1.05, 1.03-1.07), and BMI (OR 1.04, 1.01-1.08) remained significant risk factors. The mean FISI score was 20.4 +/- 12.4. Women with only flatal incontinence scored higher, and women with liquid loss scored lower on all 4 scales of the FIQL.
AI is prevalent in women seeking benign gynecologic care, and liquid stool incontinence has the greatest impact upon quality of life.
SourceAvailable from: Hege Hølmo Johannessen[Show abstract] [Hide abstract]
ABSTRACT: To evaluate the association between different types of anal incontinence (AI) and Quality of Life (QoL) in late pregnancy. Cross-sectional study. Two maternity units in Norway 2009-2010. Primiparae aged 18 or over. Participants answered questions about AI during the last 4 weeks of pregnancy on the St. Mark's score and impact of QoL in the Fecal Incontinence QoL score. Socioeconomic data were obtained from hospital records. Self-reported AI and impact on QoL. 1571 primiparae responded; 573 (37%) had experienced AI during the last 4 weeks of pregnancy. One third of the incontinent women reported reduced QoL in the domain 'Coping'. 'Women experiencing urgency alone reported markedly better QoL compared to any other AI symptoms. AI appeared to have the strongest impact on the domains 'Coping' and 'Embarrassment'. Depression was only associated with experiencing the combination of all three symptoms [odds ratio (OR) 13; 95%confidence interval (CI) 3.2-51]. Experiencing flatus alone weekly or more was associated with the highest impact on 'Embarrassment' (OR 20; 95%CI 6.4-61) compared with all other symptoms or combination of AI symptoms, except the combination of all three AI symptoms. Between 3 and 10% of the primiparae in this material experienced AI to such a extent that it affected QoL. The greatest impact was seen in the QoL domain 'Coping'. These findings highlight the importance of an increased awareness of AI in late pregnancy among health professionals and the need to implement routine discussions about AI with expectant and new mothers.BJOG An International Journal of Obstetrics & Gynaecology 03/2014; DOI:10.1111/1471-0528.12643 · 3.86 Impact Factor
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ABSTRACT: 20%. 2 Currently, the combined age-adjusted preva-lence estimates for US adults clas-sified as overweight or obese (body mass index [BMI] >25 kg/m 2) is 67.1%, 3 and for women is 64.1%. 4 Of women 60 years of age and older, 68.6% (95% confidence interval [CI], 64.4-72.7) are overweight or obese. Obesity, one of the leading health issues in the United States, results in approximately 300,000 deaths per year, 5 and it cost the nation about $147 billion in medical care costs in 2008. 6 Obesity is associated with higher rates of hypertension, diabetes mel-litus, hypercholesterolemia, osteoar-thritis, coronary artery disease, and other chronic medical conditions. 4 In recent years, studies have identified obesity as an independent risk factor for pelvic floor disorders, including urinary incontinence (UI) and fecal incontinence (FI), which are complex and underdiagnosed problems with physiologically and socially devastating consequences. 7 Additionally, evidence demonstrates that weight loss and life-style changes help to control UI 7-9 and, possibly, improve FI symptoms. 10 This article summarizes the cur-rent literature describing the effects of obesity and weight loss as they relate to urinary and fecal incontinence in women. Pathophysiology of pelvic floor disorders Although the exact etiology of pelvic floor disorders is unknown, investi-gators have demonstrated that indi-viduals with excess body weight have increased intra-abdominal pressure. 11 This, in association with upright pos-ture, increases the pressure on the pel-vic floor, including increased bladder and bowel pressure. This sequence of events is believed to potentially lead to stress UI (SUI, leakage associated with activities such as coughing, run-ning, and laughing) and may aggravate symptoms of detrusor instability and urgency urinary incontinence (UUI, leakage associated with a strong urge that is difficult to defer). Obesity may Acknowledgement Dr Richter's work was partially funded by 2K24-DK068389 from the National Institute of Diabetes and Digestive and Kidney Diseases.
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ABSTRACT: Abstract Objective. The aim of the study was to determine the alterations in the occurrence of incontinence and how subjects suffering from incontinence seek and receive healthcare services over a 10-year follow-up period. Methods. Postal questionnaires (Wexner Incontinence Score, Fecal Incontinence Quality of Life Scale, a questionnaire to investigate the management of fecal incontinence and the frequency of urinary incontinence) were sent to subjects who had reported anal incontinence in our population-based study in 2003. For each incontinent person (n = 155) from the 2003 series, we identified two control subjects (n = 310) who did not suffer from incontinence. Results. Of the initially incontinent, 47 (58%) had remained incontinent after a follow up of 10 years. Almost 80% of the incontinent subjects in 2012 were female. Of the 152 initially continent, 12 (7.9%) had developed symptoms, all of whom were females. Urinary incontinence was present in approximately 60% of incontinent subjects. The majority (57.8%) of the subjects still incontinent in 2012 felt that they needed help for the complaint, but only 30.9% had received any, and only 7.4% received any benefit. The most common treatment was medication. The subjective incontinence impaired the quality of life. Conclusion. Incontinence is a chronic long-lasting disorder. The current management of anal incontinence is not satisfactory. The primary healthcare system should be more aware of the nature of this condition to find and offer treatment for the patients.Scandinavian Journal of Gastroenterology 05/2014; DOI:10.3109/00365521.2014.915053 · 2.33 Impact Factor