Prevalence and Risk Factors of Fecal Incontinence in Women Undergoing Stress Incontinence Surgery

ABSTRACT

Introduction and Objectives: Fecal incontinence (FI) is a socially isolating disorder with a prevalence of 6-24% in women with urinary incontinence. The objective of this cross-sectional study is to evaluate the prevalence of FI subtypes (liquid and both liquid and solid stool loss) in women with stress predominant urinary incontinence (UI) and to determine which potential factors (sociodemographic, health status, history, and severity) are associated with FI.

Materials and Methods: Information was collected at baseline in 655 women enrolled in the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr). Women with FI occurring monthly were included in the analysis (n = 102). Independent variables in the analysis were: sociodemographic characteristics (age, race, education, and occupational score), health status and history (body mass index [BMI], smoking status, diabetes, obstetrical history, prior surgical history, and menopausal status), physical exam (stage of pelvic organ prolapse [POPQ], pelvic muscle strength and duration [Brink’s score], [Brink’s score]anal sphincter contraction, and urodynamic evaluation), severity of UI (accidents per day on 3-day bladder diary, pad test weight [g]) and UI symptom bother (urogenital distress inventory [UDI], incontinence impact questionnaire [IIQ], and the pelvic organ prolapse/UI sexual questionnaire [PISQ]). In univariate analysis women with incontinence of liquid stool FI (n = 64) and both liquid and solid stool FI (n = 38) were compared to women without FI (only UI) (n = 553). Multivariable logistic regression analysis models were constructed among women with monthly FI in comparison to women who did not report FI.

Results: The prevalence of monthly FI was 10% for liquid stool FI and 6% for liquid and solid FI. In univariate analysis, women with liquid stool FI and with both liquid and solid FI were more likely (p < 0.05) to have: advanced age, higher BMI, decreased anal sphincter tone, lower pelvic squeeze duration, peri and post-menopausal status, prior UI surgery, higher pad test weights, and increased symptom bother (UDI, IIQ, PISQ) compared to women without FI. Multivariate analysis demonstrated significant increased risk (odds ratio, 95% confidence interval) of monthly FI with decreased anal sphincter contraction (5.0, 2.2-11.0), use of hormone therapy (2.9, 1.3-6.3), prior UI surgery/treatment (1.7, 1.1-2.7), and increased UDI score (1.1, 1.1-1.2). Presence of detrusor overactivity was associated with a decreased risk for monthly FI (0.21, 0.1-0.7)). Prior obstetrical history (parity, vaginal delivery, and weight of the largest baby) were not associated with FI. Any fecal incontinence shared all the same risk factors as monthly incontinence, except a higher Brinks score was associated with a decreased risk of FI (0.89, 0.8-0.9).

Conclusions: Approximately 16% of women enrolled in a clinical trial of two surgical techniques for stress predominant UI reported monthly FI. The prevalence in this study may be lower than previously reported due to our strict definition of FI. Risk factors for FI included decreased anal sphincter tone, being perimenopausal, and prior UI surgery/treatment.

KEYWORDS: Stress urinary incontinence, fecal incontinence, risk factors

Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases, U01 DK58225, U01 DK58229, U01 DK58234, U01 DK58231, U01 DK60379, U01 DK60380, U01 DK60393, U01 DK60395, U01 DK60397, U01 DK60401 and DK068389. Support was also provided by the National Institute of Child Health and Human Development and Office of Research in Women’s Health, NIH.

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