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.

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Background and Purpose-To establish prevalence of urinary symptoms among community-dwelling stroke survivors and how these symptoms affected lives of these survivors compared with a nonstroke population. Methods-The present study was a community-based postal survey in Leicestershire community, UK (that excluded institutional settings), that was designed to track stroke, urinary, and bowel symptoms and the effect of such symptoms on relationships, social life, daily activities, and overall quality of life. Subjects included 14 600 people who were living in the community and Յ40 years of age, randomly selected from the Leicestershire Health Authority Register. Results-A 70% response rate was achieved with the return of 10 226 questionnaires. Prevalence of reported stroke was 4% (nϭ423). Prevalence of urinary symptoms was 34% (nϭ3197). Overall, stroke survivors had a higher prevalence of symptoms than the nonstroke population (64% to 32%, respectively). These symptoms were reported to have more of an effect on the lives of the stroke survivors compared with the nonstroke population even when adjusted for age and sex differences. This reported impact was not related to the stroke per se but to the severity of the urinary symptoms. Conclusions-These data show a high prevalence of urinary symptoms among community-dwelling stroke survivors.These symptoms were reported to have considerable impact on the lives of stroke survivors, which needs to be taken into account in future research and clinical practice.

RESULTSOf the respondents, 7.7% reported SUI monthly or more often, and 15% of those had sought help. Help-seekers reported more severe symptoms and greater impact on quality of life. Most (78%) had spoken to their GP, and 77% had received some form of treatment or advice, but only 35% had received recommended treatments. The effects on quality of life were not related to treatment provision. CONCLUSIONSMost women with SUI are treated in primary care; access to appropriate treatments is poor and may, in part, be the cause of the high levels of unmet need observed in this study. Health education interventions may aid appropriate help-seeking and self-care strategies. KEYWORDSurinary incontinence, women, quality of life, health behaviour, treatment provision OBJECTIVETo establish the prevalence of treatmentseeking in women with stress urinary incontinence (SUI), the extent and type of treatment provision, and the levels of unmet need in women who have and have not accessed care, as SUI in women is common but only a small proportion seek help, and there are reports suggesting that few women receive appropriate treatment. SUBJECTS AND METHODSA cross-sectional postal survey was conducted in which questionnaires were sent to a random sample of community-dwelling women aged ≥ 40 years, registered with

the frequency of primary UI episodes, and secondary measures were pad-test urine loss, patient perception of problem, assessment of PF function, voiding frequency, and pad usage. Validated scales for urinary dysfunction, and impact on quality of life and satisfaction were collected at an independent interview. RESULTSAll three groups had a moderate reduction in UI episodes after intervention but there was no statistically significant difference among the groups. There were marginal improvements in voiding frequency for all groups, with no statistically significant difference among them. CONCLUSIONSIn women who have already had simple behavioural therapies (including advice on PFM exercises) for urinary dysfunction, the continuation of these behavioural therapies can lead to further improvement. The addition of vaginal cone therapy or intensive PFMT does not seem to contribute to further improvement. The improvement in pelvic floor function was significantly greater in the PFMT arm than in the control arm although this did not translate into changes in urinary symptoms. KEYWORDSrandomized controlled trial, urinary incontinence, pelvic floor exercises OBJECTIVESTo assess the efficacy and cost-effectiveness of pelvic floor muscle therapies (PFMT) in women aged ≥ 40 years with urodynamic stress incontinence (USI) and mixed UI. PATIENTS AND METHODSIn a three-arm randomized controlled trial in Leicestershire and Rutland UK, 238 community-dwelling women aged ≥ 40 years with USI in whom previous primary behavioural intervention had failed were randomized to receive either intensive PFMT (79), vaginal cone therapy (80) or to continue with primary behavioural intervention (79) for 3 months. The main outcome measure was INTRODUCTIONTherapies to strengthen the pelvic floor (PF) are the most commonly recommended treatment for urodynamic stress incontinence (USI) [1,2], which is the most common form of UI in women. They have the advantage over other therapies (especially surgery) in that they have no adverse physical side-effects or morbidity. The rational use of these therapies might offer treatment to women who would not or could not undergo more invasive treatments. Recent consensus guidelines recommended combined treatment pathways for both stress and mixed UI, combining treatments for both USI and detrusor overactivity (DO).PF muscle therapy (PFMT) is designed to strengthen the PFMs, enhance the physiological closure of the bladder neck under stress, and improve co-ordination.Vaginal cone therapy (VCT) is a low-cost therapy designed to encourage the user to contract the PF to retain the cone in the vagina, and provides feedback about successful contractions; it is used as an aid to exercise and requires little professional skill in its application [3]. Both therapies have been the subject of recent Cochrane systematic reviews [1,4]. Hay-Smith et al. [1] concluded that PMFT was better than no treatment for USI, but were unable to conclude whether it was better or worse than other treatments; Herbison et al. [4] concluded...