Understanding what impacts on disclosing anal incontinence for women when comparing bowel-screening tools: a phenomenological study

Abstract

BackgroundThere is limited research defining the true prevalence of anal incontinence (AI) in women of childbearing age. Understanding the limitations of the current assessment tools in the identification of AI is paramount for identifying the prevalence of AI and improving the care and management for women of childbearing age. The aim of this research was to explore and develop an understanding of women’s experiences in disclosing AI when completing a new bowel-screening questionnaire when compared to two established AI tools.MethodsA phenomenological qualitative research study was undertaken in a maternity setting in a large tertiary hospital. Parous women in the first trimester of a subsequent pregnancy were recruited to complete a specifically designed screening tool (BSQ), St Marks Faecal incontinence score (Vaizey) and Cleveland (Wexner) score. Qualitative semi-structured interviews were utilised to identify experiences in disclosing AI.ResultsWomen (n = 16, 22–42 years) with a history of anal incontinence either following the first birth (n = 12) or the second (n = 4) provided differing responses between the three assessment tools. All women answered the BSQ while the Vaizey and Wexner scores were more difficult to complete due to clinical language and participants level of comprehension. Women identified three major themes that were barriers for disclosing incontinence, which included social expectations, trusted space and confusion.ConclusionThere are barriers for disclosing AI in the pregnant and post-natal population, which can be improved with the use of an easy assessment tool. The BSQ may facilitate discussion on AI between the patient and health professional leading to earlier identification and improvement in short and long-term health outcomes.

The role of obesity on urinary incontinence and anal incontinence in women: a review

“…There is evidence to suggest that care home residents with AI often have coexisting UI, known as double incontinence. 26 In population-based studies, UI has been found to coexist in 50% of patients with AI. 29 Risk factors for AI include: acquired structural abnormalities, for example secondary to childbirth and obstetric anal sphincter injuries; functional disorders, such as irritable bowel syndrome and inflammatory bowel disease; and neurological disorders, such as multiple sclerosis and dementia.…”

“…10,25 Barriers in disclosing incontinence have been reported, including social expectations, the lack of a 'trusted space' for disclosure, confusion surrounding the medical terminology and meaning, and emotional, social and psychological consequences. 26 Reprinted. 5 Copyright 2020 John Wiley and Sons.…”

“…Other contributors such as altered stool consistency and immobility are also likely to play a role. There is evidence to suggest that care home residents with AI often have coexisting UI, known as double incontinence 26 . In population‐based studies, UI has been found to coexist in 50% of patients with AI 29…”

Identifying the health care–initiated and self-initiated interventions used by women for the management of rectal emptying difficulty secondary to obstructive defecation: a scoping review protocol

“…30 The relationship between a woman and personal bowel function appears to be a largely private affair and it takes courage for some to discuss these concerns with health care professionals. 31 Fear and shame may lead women to find intuitive ways of managing their issue, such as digitation, without seeking a health care-initiated intervention. Digitation can be an uncomfortable process requiring good dexterity; it does not always work, and can present additional problems with co-morbidities or increased age.…”

“…Problems with low self-esteem are also often identified during clinical consultations 30 . The relationship between a woman and personal bowel function appears to be a largely private affair and it takes courage for some to discuss these concerns with health care professionals 31 . Fear and shame may lead women to find intuitive ways of managing their issue, such as digitation, without seeking a health care–initiated intervention.…”