FECAL INCONTINENCE IN U.S. WOMEN: A POPULATION-BASED STUDY

J. Melville, K. Newton, D. Fenner

University of Washington School of Medicine

Harborview Medical Center

Seattle, WA 

OBJECTIVE:  To determine the prevalence of fecal incontinence (FI) and associated risk factors in a broad age range of adult, community-dwelling women.

MATERIALS AND METHODS:  We conducted a population-based, age-stratified postal survey of 6,000 women aged 30 to 90 years enrolled in a large health maintenance organization in Washington State.  The sample was stratified by decade of age with over-sampling of younger decades to ensure a sufficient number of respondents with FI in each age group.  FI, urinary incontinence (UI), demographics, height, weight, menopausal status, and delivery types were assessed by self-report.  FI was defined as loss of liquid or solid stool at least once per month.  UI was defined as loss of urine at least once per month.  The Patient Health Questionnaire was used to diagnose major depression.  Functional disability was measured with the World Health Organization Disability Assessment Schedule II.  The sample was linked to longitudinal automated data, including age, physician diagnoses, and a medical comorbidity measure.  Descriptive statistics were used to characterize the overall sample and subjects with and without FI.  Comparisons of variables by FI status were conducted using chi square tests for categorical variables and t tests or ANOVA for continuous variables.  To predict the odds of FI, adjusted odds ratios (OR) and 95% confidence intervals were estimated using logistic regression models.

RESULTS:  The response rate was 64% (n=3,536) after exclusion criteria. The prevalence of FI was 7.3%.  Prevalence increased with age, from 3.6% of 30- to 39-year-olds to 15.2% of 80- to 90-year-olds.  Among those with FI, 58% reported leakage of stool one-to-three times per month, while 42% reported leakage of stool one-or-more times per week.  Forty-six percent of subjects with FI reported use of a pad and 53% reported alteration of their lifestyle because of stool incontinence.  Seventy percent of subjects with FI had comorbid UI.  Women with FI had significantly greater functional disability than women without FI (23.4 versus 10.8; f(1)=192.44, p<0.001).  Older age [50-69 years, OR=2.23 (1.56, 3.18); 70-90 years, OR=2.77 (1.86, 4.12)], degree of medical comorbidity [moderate, OR=1.75 (1.14, 2.69); high, OR=2.48 (1.61, 3.82)], current UI [OR=2.15 (1.61, 2.89)], current major depression [OR=2.75 (1.67, 4.50)], and history of operative vaginal delivery [OR=1.44 (1.04, 1.98)] were each significantly associated with increased odds of FI.

CONCLUSIONS:  In this large report of community-dwelling women in the United States, FI was prevalent and increased with age.  Age, medical illness, urinary incontinence, major depression, and operative vaginal delivery were each strongly associated with likelihood of FI.

Key Words:  fecal incontinence, prevalence, operative vaginal delivery

Disclosure - Grant/Research: J. Melville, Pharmacia Corporation.