Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis

Chassagne, Philippe; Landrin, I; Neveu, Christophe; Czernichow, P.; Bouaniche, M; Doucet, J.; Denis, Philippe; Bercoff, É.

doi:10.1016/s0002-9343(98)00407-0

Cited by 155 publications

(89 citation statements)

References 32 publications

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“…13,14 In stroke patients specifically, treatment of depression during the first 2 years after stroke has been shown to enhance recovery of ADL functions. 15 Poor mobility is a known independent risk factor for FI in elderly persons, 16,17 although mobility is only 1 aspect of needing help to use the toilet. Other contributory factors in stroke patients include 18,19 by reducing contractility of the smooth muscle of the gut by an antimuscarinic effect at acetylcholine receptor sites; in some cases, long-term use may induce chronic colonic dysmotility.…”

Section: Discussionmentioning

confidence: 99%

New-Onset Fecal Incontinence After Stroke

Harari

Coshall

Rudd

et al. 2003

Stroke

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Background and Purpose-Fecal incontinence (FI) is a common complication after stroke, yet epidemiological research into this distressing condition is limited. The purpose of this study was to describe the prevalence, natural history, associations, and impact of new-onset FI after stroke. Methods-Stroke patients in the community-based South London Stroke Register (January 1995 to 2000) without preexisting FI were characterized regarding bowel continence at 7 to 10 days, 3 months, and 1 and 3 years after stroke. FI was defined as any degree of bowel leakage. Results-Prevalence of poststroke FI was 30% (7 to 10 days), 11% (3 months), 11% (1 year), and 15% (3 years). One third of patients with FI at 3 months were continent by 1 year; conversely, 63% incontinent at 1 year had been continent at 3 months. Characteristics of 91 patients with FI and 755 without FI at 3 months were compared using multiple logistic regression. Acute stroke associations of neglect (adjusted odds ratio [OR], 1.9; 95% CI, 1.0 to 3.5) and initial urinary incontinence (OR, 6.2; 95% CI, 3.2 to 11.9) were no longer significant after adjustment for clinical factors at 3 months. Final independent associations were anticholinergic drug use (OR, 3.1; 95% CI, 1.1 to 10.2) and needing help with toilet use (OR, 3.5; 95% CI, 1.4 to 17.3). FI at 3 months increased the risk of long-term placement (28% vs 6%) and death within 1 year (20% vs 8%). Conclusions-New-onset FI in stroke survivors is common but may be transient.

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Section: Discussionmentioning

confidence: 99%

New-Onset Fecal Incontinence After Stroke

Harari

Coshall

Rudd

et al. 2003

Stroke

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“…In the institutionalized patient, ritualizing their bowel habit and instituting cognitive training may prove beneficial. These measures are important, failing which these patients have been shown to have a higher mortality compared to those without incontinence (130).…”

Section: Supportive Measuresmentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

286

295

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DEFINITIONFecal incontinence is defined as either the involuntary passage or the inability to control the discharge of fecal matter through the anus. Clinically there are three subtypes (a) passive incontinence-the involuntary discharge of stool or gas without awareness; (b) urge incontinence-the discharge of fecal matter in spite of active attempts to retain bowel contents, and (c) fecal seepage-the leakage of stool following otherwise normal evacuation. The severity of incontinence can range from the unintentional elimination of flatus to the seepage of liquid fecal matter or sometimes the complete evacuation of bowel contents. Not surprisingly, these events cause considerable embarrassment, which in turn can lead to a loss of self-esteem, social isolation, and a diminished quality of life (1). EPIDEMIOLOGYAlthough fecal incontinence affects people of all ages, its prevalence is disproportionally higher in women, in the elderly, and in nursing home residents. Estimates of its prevalence vary greatly and depend on the clinical setting, the influence of social stigma, the definition of incontinence, and the frequency of occurrence.In the U.S. householder survey, frequent leakage of stool or fecal staining for more than 1 month was reported by 7.1% and 0.7% of the population, respectively (2). In contrast, two or more episodes of fecal incontinence per month were reported by 0.8% of patients presenting to primary care clinics in the UK (3). In an elderly (>65 yr) self-caring population, fecal incontinence occurred at least once a week in 3.7% of subjects and in more men than women (men:women = 1.5:1) (4). In contrast, 25-35% of institutionalized patients (5) and 10-25% of hospitalized geriatric patients (6) suffer from fecal incontinence. In the United States, fecal incontinence is the second leading cause for placement in nursing homes (6).In a survey of 2,570 households, comprising 6,959 individuals, the prevalence of at least one episode of incontinence during the previous year was 2.2%; among these 63% were women, 30% were >65 yr of age, 36% were incontinent of solid stool, 54% of liquid stool, and 60% of flatus (7). Furthermore, in another prospective survey of patients attending either a gastroenterology or a primary care clinic, over 18% reported fecal incontinence at least once a week (8). Only one third had ever discussed the problem with a physician (8). When stratified for the frequency of episodes, 2.7% of patients reported daily incontinence, 4.5% weekly, and 7.1% once per month (8). In another survey, fecal incontinence was associated with urinary incontinence in 26% of women attending a Uro/Gyn Clinic (9). A higher incidence of mixed fecal and urinary incontinence was also reported in nursing home residents (10, 11).The cost of health care related to fecal incontinence includes items that can be measured such as the evaluation, diagnosis and treatment of incontinence, medications, the use of disposable pads and other ancillary devices, skin care, and nursing care. Approximately $400 million/year we...

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“…Tokie pacientai buvo silpniausi ir pažeidžiamiausi (28)(29)(30). Mūsų tyrimo ir užsienio autorių duomenys panašūs.…”

Section: Odeta Kučikienė Vita Lesauskaitė Jūratė Macijauskienė Godunclassified

Assessment of urinary incontinence in the elderly using the InterRAI-AC instrument

et al. 2009

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Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis

Cited by 155 publications

References 32 publications

New-Onset Fecal Incontinence After Stroke

New-Onset Fecal Incontinence After Stroke

Diagnosis and Management of Fecal Incontinence

Assessment of urinary incontinence in the elderly using the InterRAI-AC instrument

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