Epidemiology of Surgically Managed Fecal Incontinence
                Drs. S. Renee Edwards, Thomas Gregory, Virginia Smith, Amanda Clark
                Oregon Health Science Center
                Portland Oregon

Objective: To determine the incidence of surgically managed fecal incontinence in a population-based cohort.
Materials and Methods: This descriptive study includes all female members of Kaiser Permanente Northwest greater than 20 years of age undergoing a surgical procedure for the treatment of fecal incontinence from 1/1/1995 through 12/31/2000.   Average annual enrollment during this 6 year time period was 160,668 women.  For the patients identified, charts were reviewed to determine patient characteristics including age, parity, potential sphincter damaging events, and other pelvic organ prolapse or urinary incontinence procedures.  Analysis included calculation of mean annual incidence and determination of primary versus repeat procedures.
Results: 16 of 964,006 women underwent surgical treatment to correct fecal incontinence due to a disrupted anal sphincter, one of whom had a total of three procedures.  The mean annual incidence of anal sphincter procedures was 2 per 100,000 women.  63% of patients were 20-40 years of age.  None was over 70 years of age and only 2 were over 60 years of age.  Three of 16 patients (19%) also underwent procedures for pelvic organ prolapse or urinary incontinence. 
Conclusions: In a population-based cohort, the incidence of surgically managed fecal incontinence is low, despite a predicted population prevalence of fecal incontinence of at least 2%.  This is consistent with previous findings of the under-reported nature of fecal incontinence to health care providers and underscores the importance of routine inquiry about this condition. 
Key Words: fecal incontinence, anal sphincteroplasty, epidemiology