Anal incontinence in women presenting for gynecologic care: prevalence, risk factors and impact upon quality of life. Am J Obstet Gynecol

University of Alabama at Birmingham, Birmingham, Alabama, United States
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 06/2005; 192(5):1637-42. DOI: 10.1016/j.ajog.2004.11.030
Source: PubMed

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.

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    • "This is in contrast to some previous studies, where previous forceps delivery and macrosomy are reported as risk factors for AI [8, 26, 27]. In our study of pregnant women, maternal age was not a significant risk factor for AI in the subgroup of parous women, probably because our study group was young, the oldest participant was 45 years old, and age related increased risk of anal incontinence is probably more important in older age groups [2, 5, 27]. Women with overweight (BMI 25–29.9) "
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    ABSTRACT: The aim of this study was to assess the prevalence and risk factors of anal incontinence in an unselected pregnant population at second trimester. A survey of pregnant women attending a routine ultrasound examination was conducted in a university hospital in Oslo, Norway. A questionnaire consisting of 105 items concerning anal incontinence (including St. Mark’s score), urinary incontinence, medication use, and comorbidity was posted to women when invited to the ultrasound examination. Results . Prevalence of self-reported anal incontinence (St. Mark’s score ≥ 3) was the lowest in the group of women with a previous cesarean section only (6.4%) and the highest among women with a previous delivery complicated by obstetric anal sphincter injury (24.4%). Among nulliparous women the prevalence of anal incontinence was 7.7% and was associated to low educational level and comorbidity. Prevalence of anal incontinence increased with increasing parity. Urinary incontinence was associated with anal incontinence in all parity groups. Conclusions . Anal incontinence was most frequent among women with a history of obstetric anal sphincter injury. Other obstetrical events had a minor effect on prevalence of anal incontinence among parous women. Prevention of obstetrical sphincter injury is likely the most important factor for reducing bothersome anal incontinence among fertile women.
    ISRN obstetrics and gynecology 05/2013; 2013(5):947572. DOI:10.1155/2013/947572
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    • "Office-based studies document that 13% to 29% of patients in primary care and specialty clinics admit to FI when asked [7] [10] [11] [13] [14]. Studies from obstetrics and gynecology, urogynecology, and antenatal outpatient clinics report prevalences between 5.6% and 29% [9] [14] [15]. "
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    ABSTRACT: Background. The prevalence of fecal incontinence varies tremendously as a result of inadequate data collection methods. Few office-based studies have assessed the prevalence of fecal incontinence and none have looked at modifiable risk factors or effect on quality of life. Design, Settings, Patients, and Main Outcome Measures. Five hundred patients who visited our inner city, university-based gastroenterology practice, were asked about symptoms of fecal incontinence. We also retrospectively reviewed 500 charts to identify the frequency of patient-physician reporting of fecal incontinence. Results. Of the 500 patients that were directly questioned, 58 (12%, 43 women, 15 men) admitted to fecal incontinence compared to 12 (2.4%) in the retrospective arm. Patients with fecal incontinence and loose/watery stool reported the lowest quality of life scores. While the average severity score was similar between men and women, women had a significantly lower average quality of life score (3.04 versus 2.51; P < 0.03). Conclusions. The identification of fecal incontinence increases when patients are directly questioned. Identifying and treating patients with loose stool is a potential strategy to improve quality of life in this patient population. In men and women with similar severity of fecal incontinence, women have a significantly lower quality of life.
    Gastroenterology Research and Practice 01/2012; 2012(1):947694. DOI:10.1155/2012/947694 · 1.75 Impact Factor
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    ABSTRACT: The aim of this study was to assess the correlation between St. Mark’s incontinence score (SMIS) for anal incontinence and impact on quality of life (QoL), following primary repair of obstetric anal sphincter injuries (OASIS). Three hundred sixty-eight women who sustained OASIS completed a Manchester Health Questionnaire (MHQ) and the clinician calculated a SMIS. Spearman’s correlation coefficients were calculated, and Mann–Whitney U test was used to compare different severity subgroups. Mean follow-up was 10weeks and mean age was 30years. Mean SMIS was 1.35. All MHQ QoL domains showed statistically significant positive correlation with SMIS. When comparing SMIS subgroups (0–4, 5–8, >8), mean QoL domain scores were higher with increasing SMIS. This shows that the objective assessment of severity of anal incontinence, using the SMIS, correlates to its impact on QoL in a relatively young population with low severity of symptoms and can, therefore, be used in women who sustain OASIS.
    International Urogynecology Journal 04/2009; 20(4):407-410. DOI:10.1007/s00192-008-0784-7 · 1.96 Impact Factor
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