Prevalence of faecal incontinence in the community: a cross-sectional study in Singapore

Abstract

INTRODUCTIONFaecal incontinence (FI) is frequently referred to as a 'silent epidemic', explaining the inherent difficulty in obtaining reliable data that is reflective of the study population. FI is a socially stigmatised condition that is extremely distressing to its sufferers, and a cause of both physical and psychological morbidity. While sufferers from all age groups have been reported, FI is known to predominantly affect the elderly.(1) The predicament of this group of patients is worsened by the embarrassment associated with the condition and the lack of public education, both of which result in patients suffering in silence instead of seeking appropriate medical treatment.Previous population studies have faced criticisms related to the variable definitions of FI, the use of non-validated assessment tools, poor response rates and nonrepresentative populations that are unable to reflect the true prevalence of FI in the general population.(1-3) These issues largely stem from a lack of consensus regarding the definition of FI and the appropriate assessment tools, as well as difficulties faced when trying to administer these assessment tools to the appropriate study population (given the sensitive nature of the condition). Previous studies have reported a wide range of prevalence rates of FI within the general population (0.8%-18.0%).(1-3) Moreover, the inconsistent definition of FI -defined as the involuntary loss of control over the release of solid stools, liquid stools and/or gas -has accounted partly for the wide ranging prevalence rates in the aforementioned studies.The primary objectives of the present study were to determine the prevalence of FI in the general Singapore population and to identify possible at-risk groups. It is our hope that this study, the first of its kind in Singapore, will give us valuable insight into this often neglected but significant condition in the local context, as well as enable healthcare administrators to more efficiently allocate the necessary resources to meet the needs of these vulnerable subgroups of patients. METHODSWe identified a minimum sample size of 380 subjects for this study, based on a 10% estimated prevalence of FI in the general population and a 3% (95% confidence interval) margin of error. Via a computer-generated number allocation system, 1,000 subjects above the age of 21 years were randomly selected from the national electoral roll. In view of the prevailing data that women are at risk of developing FI, (4,5) we sampled 500 subjects from each gender (i.e. gender-stratified sampling was performed) to reduce sampling bias.The primary component of the questionnaire used was the Comprehensive Fecal Incontinence Questionnaire (CFIQ), a validated and reliable assessment tool designed and tested in the general population of Auckland, New Zealand, by Macmillan et al. The CFIQ assesses both the severity of FI and its impact on quality of life. In addition, to assess whether the subjects perceived that they were suffering from a bowel control problem, the CFIQ in...

Systematic review of the prevalence of faecal incontinence

“…Prevalence rates ranged from 1⋅4 to 19⋅5 per cent 15 -44 . All but five studies 23,24,30,32,42 were able to give 95 per cent confidence intervals within 2 per cent of the FI prevalence estimate. Included studies were heterogeneous with regard to minimum age of recruitment, response rate, study methodology and study definition.…”

“…Nine studies included various severity scales in their definitions, including: Faecal Incontinence Severity Index (FISI), St Mark's tool by Vaisey and colleagues, the Wexner score by Miller et al ., and one developed by Bharucha and colleagues. Despite use of comparable severity scores, estimated prevalence rates varied widely (1·5–17·0 per cent), likely reflecting the heterogeneity of stool type and frequency definitions used by the different studies.…”

“…Validated questionnaires were used by 12 studies. Three of these did not specifically validate their questionnaire but used the FISI or Wexner scoring systems, both of which have been validated previously in patient populations.…”

Differences in innervated neurons of the internal anal sphincter based on age and sex: A histological study

“…[2][3][4][5] The incidence of fecal incontinence based on sex is controversial. 4,5 However, examination of anal function using manometry has shown a difference in fecal incontinence associated with age, as well as sex. 2,3 In contrast, other reports have suggested that fecal incontinence is more common in women than in men.…”

Prevalencia De Incontinencia Fecal en Personas Que Acuden a Policlínicosde Un Hospital Universitario

“…En la literatura internacional existe una gran variabilidad y discordancia con respecto al tema, dependiendo de la población y método de estudio utilizado, sin embargo, un rango entre 2 y 18% en población general es lo más aceptado 4,[10][11][12][13][14][15][16][17] . Encontramos un estudio de Zárate et al, del año 2008, que presenta una prevalencia de IF a gases de un 20,5% y a sólidos y líquidos de un 2,7%…”