Background: Prevalence studies of faecal incontinence in the general population are rare and the impact of faecal incontinence on quality of life has not been previously addressed. Aims: To establish the prevalence of faecal incontinence in adults in terms of frequency of leakage, degree of soiling, and level of impact on quality of life. Methods: In a cross sectional postal survey, 15 904 adults aged 40 years or more (excluding residents of nursing and residential homes) were selected randomly by household from the Leicestershire Health Authority patient register. Participants were asked to complete a confidential health questionnaire. Major faecal incontinence was defined as soiling of underwear or worse with a frequency of several times a month or more. Respondents were also asked if bowel symptoms had an impact on their quality of life. Results: From a total sample of 10 116 respondents, 1.4% reported major faecal incontinence and 0.7% major faecal incontinence with bowel symptoms that had an impact on quality of life. Major faecal incontinence was significantly associated with a lot of impact on quality of life (odds ratio 12.4, 95% confidence interval 7.5-20.6). Incontinence was more prevalent and more severe in older people but there was no significant difference between men and women. Conclusions: This study has confirmed that faecal incontinence is a fairly common symptom, particularly in older people. Faecal incontinence in men has received little attention in the past and the results from this study indicate that it is as much of a problem in men as it is in women while the level of unmet need in this group is high. Estimates of need for health care for this symptom should be multidimensional and assess both the severity of symptoms and the impact it has on quality of life.

A cause-and-effect relation between protein-energy malnutrition and poor outcome in acute stroke patients has not been definitively established. To measure the effect of the nutritional status of hospitalized stroke patients on clinical outcome, a prospective, observational study was performed. Acute stroke patients admitted to Leicester General Hospital from June 1994 to October 1995 had their nutritional status assessed with anthropometric, hematologic, and biochemical methods within 48 h of admission and after 2 and 4 wk. Outcome measures including disability, handicap, length of stay, morbidity (infective complications), discharge destination, and mortality were recorded during the hospital stay and at 3 mo. Nutritional status deteriorated significantly during the study period, but only serum albumin concentrations showed a significant association with various outcome measures. Stroke patients with hypoalbuminemia had a greater risk of infective complications (P<0.0001) and poor functional outcome during hospitalization than those with normal or higher serum albumin concentrations. Serum albumin concentrations were good predictors of the degree of disability and handicap during the hospital stay. After prognostic indicators of poor outcome were adjusted for, serum albumin concentration in the hospital was a strong and independent predictor of mortality at 3 mo after acute stroke [hazard ratio 0.91 (95% CI: 0.84, 0.99) for a 1-g/L higher serum albumin concentration]. Whether nutritional supplementation removes or mitigates the hazard of poor outcome associated with undernutrition after acute stroke needs to be determined.

Urinary symptoms are very common in adults over 40 years of age living in the community. However, symptom-based estimates probably overestimate the level of need for health care in the community. It may be more effective and efficient to target services, in the first instance, on those people who report clinically significant symptoms that are bothersome or socially disabling. A consensus on thresholds and definitions of urinary symptoms is required to standardize clinical and research work and to target services more appropriately.

Background-Urinary incontinence in the acute stage of stroke is seen as a predictor of death, severe disability, and an important factor on hospital discharge destination. Therefore, it is an important measure of stroke severity that not only affects the lives of stroke survivors but also those of caregivers. Summary of Review-A number of studies have linked the presence of bladder dysfunction in stroke survivors to various neurological lesions in areas thought to be primarily involved in micturition. However, neurological deficits may affect management of bladder control secondarily by apraxia or aphasia, for example, and a significant number of strokes occur in individuals already experiencing incontinence. Conclusions-Despite incontinence being such an important prognostic feature, there are many gaps in our knowledge of the relationship of stroke and incontinence, particularly fecal incontinence. There are almost no studies on the influence of achieving continence on outcome or how this might be brought about. This article reviews the literature on this important topic and highlights deficiencies in our knowledge and areas of future research. (Stroke. 1998;29:524-528.)

frequency or nocturia above clinically defined thresholds), storage symptoms (as for storage disorder, above epidemiologically defined thresholds), professionally defined healthcare need (storage disorder, or storage symptoms with an impact on quality of life, QoL), and healthcare requirement (using services or wanting help among those with a healthcare need), all within the last year. RESULTSThe period prevalence was: moderate or greater incontinence, 16.1%; storage disorder, 28.5%; storage symptoms with impact on QoL, 30.4%; healthcare need, 37.1% and requirement 20.4%. Among those with storage disorders 81% reported effects on QoL. Annual incidence rates were: incontinence, 6.3%; storage disorder, 14.1%; healthcare need, 15.6% and requirement 8.4%. The remission rates were substantially greater in men than women. The problem becomes increasingly established and less likely to remit with age. CONCLUSIONSIn the UK over a 1-year period, over a third of people aged ≥ 40 years are estimated to have a healthcare need for urinary storage symptoms (i.e. 9 million) and a fifth (i.e. 5 million) are estimated to require healthcare, with unmet requirement affecting 3 million. This represents a major public health problem. Apparent inconsistencies between prevalence, impact and uptake of services are explained. KEYWORDSprevalence, incidence, urinary disorders, urinary incontinence, need, residential facilities OBJECTIVETo establish valid and reliable prevalence and incidence rates for urinary incontinence and storage disorder, and estimate the extent of healthcare need and requirement for the UK. SUBJECTS AND METHODSThis was a cross-sectional and longitudinal population-based study involving registrants with 108 general practices in Leicestershire and Rutland counties (UK). In all, 162 533 (prevalence study) and 39 602 (incidence study) people aged ≥ 40 years were approached by postal questionnaire, with response rates of 60% and 63%, respectively; 1050 non-responders were followed up. The main measures were incontinence (involuntary leakage) storage disorder (including incontinence or urgency or