Prevalence and Burden of Fecal Incontinence: A Population-Based Study in Women

Bharucha, Adil E.; Zinsmeister, Alan R.; Locke, G. Richard; Seide, Barbara M.; McKeon, Kimberly; Schleck, Cathy D.; Melton, L. Joseph

doi:10.1053/j.gastro.2005.04.006

Cited by 307 publications

(241 citation statements)

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“…Using a validated mailed questionnaire, we identified 507 women with fecal incontinence (FI) among an age-stratified random sample of 5,300 women of Olmsted County, MN (14). Thereafter, 400 women (200 FI and 200 controls) selected at random were invited to participate in a case-control study.…”

Section: Methodsmentioning

confidence: 99%

Insights Into Normal and Disordered Bowel Habits From Bowel Diaries

Bharucha¹,

Seide²,

Zinsmeister

et al. 2008

The American Journal of Gastroenterology

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Section: Methodsmentioning

confidence: 99%

Insights Into Normal and Disordered Bowel Habits From Bowel Diaries

Bharucha¹,

Seide²,

Zinsmeister

et al. 2008

The American Journal of Gastroenterology

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“…FECAL INCONTINENCE (FI) is extremely common and reported by 7-10% of women over 60 years of age (1,3,4). Childbirthrelated injury to the muscles of the anal sphincter complex is a possible cause of FI in women (11,26).…”

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confidence: 99%

Myoarchitectural and functional alterations in rabbit external anal sphincter muscle following experimental surgical trauma

Rajasekaran

Sinha

Seo

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

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Rajasekaran MR, Sinha S, Seo Y, Salehi M, Bhargava V, Mittal RK. Myoarchitectural and functional alterations in rabbit external anal sphincter muscle following experimental surgical trauma. Am J Physiol Gastrointest Liver Physiol 307: G445-G451, 2014. First published July 3, 2014; doi:10.1152/ajpgi.00450.2013.-Obstetrical trauma to external anal sphincter (EAS) is extremely common; however, its role in the development of anal incontinence is not clear. We examined the regenerative process and functional impact of experimental surgical trauma to EAS muscle in an animal model. Surgical myotomy, a craniocaudal incision extending along the entire length and thickness of the EAS, was performed in rabbits. Animals were allowed to recover, and anal pressures were recorded at weekly intervals for 12 wk using a custom-designed probe system to determine the length-tension property of EAS muscle. Animals were killed at predetermined time intervals, and the anal canal was harvested for histochemical studies (for determination of muscle/connective tissue/ collagen) and sarcomere length measurement. In addition, magnetic resonance diffusion tensor imaging (MR-DTI) and fiber tracking was performed to determine myoarchitectural changes in the EAS. Myotomy of the EAS muscle resulted in significant impairment of its length-tension property that showed only partial recovery during the 12-wk study period. Histology revealed marked increase in the fibrosis (connective tissue ϭ 69% following myotomy vs. 28% in controls) at 3 wk, which persisted at 12 wk. Immunostaining studies confirmed deposition of collagen in the fibrotic tissue. There was no change in the sarcomere length following myotomy. MR-DTI studies revealed disorganized muscle fiber orientation in the regenerating muscle. We conclude that, following experimental injury, the EAS muscle heals with an increase in the collagen content and loss of normal myoarchitecture, which we suspect is the cause of impaired EAS function. length-tension; fibrosis; magnetic resonance diffusion tensor imaging FECAL INCONTINENCE (FI) is extremely common and reported by 7-10% of women over 60 years of age (1, 3, 4). Childbirthrelated injury to the muscles of the anal sphincter complex is a possible cause of FI in women (11,26). The injury to these muscles occurs through several mechanisms. First is the stretch of the muscles caused by the fetus during its passage through the birth canal. Second is the trauma related to instrumentation, and third is surgical episiotomy. Women who sustain thirddegree obstetrical tear develop FI soon after delivery if muscles are not properly repaired (13). However, in the significant majority of women, injury to the anal sphincter and other pelvic floor muscle is occult. Symptoms develop in the fifth to sixth decade of life, the reasons for which are not clear.Of the three components of the anal sphincter complex [the internal anal sphincter, external anal sphincter (EAS), and puborectalis muscle (PRM)], it is generally believed that EAS muscle plays a significan...

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“…In population-based studies, FI affects 2-12% of community-dwelling adults 9,10 and is associated with significant adverse impact on quality of life (QOL). 9 Although several case series report the impact of postpartum UI on QOL, 3,4,6 data are very limited on the impact of FI on QOL in the postpartum period.…”

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confidence: 99%

The impact of fecal and urinary incontinence on quality of life 6 months after childbirth

Handa

Zyczynski

Burgio

et al. 2007

American Journal of Obstetrics and Gynecology

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Objective-The objective of the study was to investigate the impact of postpartum fecal incontinence (FI) and urinary incontinence (UI) on quality of life (QOL). Study Design-Seven hundred fifty-nine primiparous women in the Childbirth and PelvicSymptoms study were interviewed 6 months postpartum. FI and UI were assessed with validated questionnaires. We measured QOL with SF-12 summary scores, health utility index score (a measure of self-rated overall health), and the modified Manchester Health Questionnaire.Results-Women with FI had worse self-rated health utility index scores (85.1 ± 9.8 vs 88.0 ± 11.6, P = .02) and Medical Outcomes Study Short Form Health Survey (SF-12) mental summary scores (46.8 ± 9.2 vs 51.1 ± 8.7, P < .0001) than women without FI or flatal incontinence. Women with UI had worse SF-12 mental summary scores (48.3 ± 9.8 vs 51.6 ± 7.8, P < .01) and self-rated health utility index scores (84.1 ± 12.5 vs 88.7 ± 10.1, P < .01) than women without UI. Women with both FI and UI had the lowest SF-12 mental summary scores (44.5 ± 9.0).Conclusion-Six months after delivery, women experiencing FI or UI reported negative effects on health-related QOL. FI and UI together have a greater impact than either condition alone. Keywords childbirth; fecal incontinence; quality of life; urinary incontinenceIn studies of fecal incontinence (FI) and urinary incontinence (UI) during the postpartum period, UI is reported by 10-50% of women, [1][2][3][4][5][6] whereas FI is present in up to 25%. 2,3,7 The Pelvic Floor Disorders Network (PFDN) has previously published findings of the Childbirth and Pelvic Symptoms (CAPS) study, 8 which examined the prevalence of FI and UI in 3 cohorts of primiparous women. FI was more prevalent (17.0%) in women who delivered vaginally with recognized anal sphincter tears, compared with women who delivered Reprints not available from the authors. NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2011 April 13.Published in final edited form as: Am J Obstet Gynecol. 2007 December ; 197(6): 636.e1-636.e6. doi:10.1016/j.ajog.2007.08.020. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript vaginally without recognized anal sphincter tears (8.2%) and women who delivered by cesarean prior to labor (7.6%). UI was reported by 31.2% of participants and did not differ significantly by group.In population-based studies, FI affects 2-12% of community-dwelling adults 9,10 and is associated with significant adverse impact on quality of life (QOL). 9 Although several case series report the impact of postpartum UI on QOL, 3,4,6 data are very limited on the impact of FI on QOL in the postpartum period. In a Canadian study, 3 FI was present in 20.6% of 1305 primiparous women 6 months postpartum, and QOL varied significantly with the severity of both FI and UI.The objective of this study was to examine the impact of postpartum FI and UI, alone and in combination, on health-related QOL in a cohort of primiparous American women. Materials ...

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Prevalence and Burden of Fecal Incontinence: A Population-Based Study in Women

Cited by 307 publications

References 31 publications

Insights Into Normal and Disordered Bowel Habits From Bowel Diaries

Insights Into Normal and Disordered Bowel Habits From Bowel Diaries

Myoarchitectural and functional alterations in rabbit external anal sphincter muscle following experimental surgical trauma

The impact of fecal and urinary incontinence on quality of life 6 months after childbirth

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