Fecal Incontinence Decreases Sexual Quality of Life, But Does Not Prevent Sexual Activity in Women

Abstract

Background The impact of anal incontinence on women’s sexual function is poorly understood. Objective To investigate the relationship between anal incontinence and sexual activity and functioning in women. Design Cross-sectional study. Settings Community-based integrated healthcare delivery system. Patients 2,269 ethnically-diverse women aged 40 to 80 years. Main Outcome Measures Self-administered questionnaires assessed accidental leakage of gas (flatal incontinence) and fluid/mucus/stool (fecal incontinence) in the past 3 months. Additional questionnaires assessed sexual activity, desire and satisfaction, as well as specific sexual problems (difficulty with arousal, lubrication, orgasm, or pain). Multivariable logistic regression models compared sexual function in women with 1) isolated flatal incontinence, 2) fecal incontinence (with or without flatal incontinence), and 3) no fecal/flatal incontinence, controlling for potential confounders. Results Twenty-four percent of women reported fecal incontinence and 43% reported isolated flatal incontinence in the prior 3 months. The majority were sexually active (62% of women without fecal/flatal incontinence, 66% with isolated flatal incontinence, and 60% with fecal incontinence; p=0.06). Compared to women without fecal/flatal incontinence, women with fecal incontinence were more likely to report low sexual desire (OR:1.41 [CI:1.10–1.82]), low sexual satisfaction (OR:1.56 [CI:1.14–2.12]), and limitation of sexual activity by physical health (OR:1.65 [CI:1.19–2.28]) after adjustment for confounders. Among sexually active women, women with fecal incontinence were more likely than women without fecal/flatal incontinence to report difficulties with lubrication (OR:2.66 [CI:1.76–4.00]), pain (OR:2.44 [CI:1.52–3.91]), and orgasm (OR:1.68 [CI:1.12–2.51]). Women with isolated flatal incontinence reported similar sexual functioning to women without fecal/flatal incontinence. Limitations Cross-sectional design prevented evaluation of causality. Conclusions While most women with anal incontinence are sexually active, those with fecal incontinence are at high risk for several aspects of sexual dysfunction. This indicates that sexual function is important to women with anal incontinence and should be prioritized during therapeutic management.

Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula

“…Regarding the occurrence of fecal incontinence in the present study according to Fecal Incontinence Severity Index [8] was 2% patients in fistulotomy and 4% in fistulectomy group that came in agreement of this recent study from Japan that reported temporary minor incontinence of 4% of fistulectomy patients [12]. Another recent study found that fistulectomy is associated with a higher rate of incontinence 50% versus 25% in fistulotomy since muscle separation necessarily occurs after excision of the complete tract [13].…”

“…3) Accidental leakage of mucus, liquid or solid stool with or without leakage of gas (fecal incontinence [FI] with or without flatal incontinence) [8].…”

Anal incontinence and Quality of Life in late pregnancy: a cross‐sectional study

“…34 Some authors indicate that increasing levels of frequency and quantity of incontinence have a negative impact on usual everyday activities as well as on general and sexual QoL in patients with long-standing AI. [34][35][36] The occurrence of incontinence episodes less than once a month is reported to have a lower impact on QoL than more frequent incontinence episodes; however, one study found monthly and weekly episodes of stool incontinence to be equally distressing for patients with long-standing AI. 35 In contrast to previous reports of flatus incontinence at any frequency being the least bothersome symptom of AI 31 , the findings in this study suggest that experiencing flatus incontinence alone on a weekly or daily basis has a profound negative impact on QoL, especially in the domain 'Embarrassment'.…”

Anal Intercourse and Fecal Incontinence: Evidence from the 2009–2010 National Health and Nutrition Examination Survey

“…Although specific sexual practices of women with FI are undescribed, women with FI are as likely to be sexually active as women without FI but their sexual function scores are lower (7,8). Studies evaluating the impact of FI treatment on sexual function are limited to descriptions in small populations following sphincteroplasty, with most studies reporting improved function and less embarrassment with sexual activity following treatment for FI (9–11).…”