Menopause and Obstetric History as Risk Factors for Fecal Incontinence in Women

Bohle, Bernhard; Belvis, Francesc; Vial, Manuel; Maestre, Yolanda; Pera, Miguél; Castillo, Maite; Grande, Luís; Parés, David

doi:10.1097/dcr.0b013e31821c404a

Cited by 17 publications

(10 citation statements)

References 30 publications

(39 reference statements)

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“…In a recent cross-sectional study, among 332 women, menopause was found to be an independent risk factor for FI, but the risk of FI did not increase among women aged 60 years and older. 24 FI was defined as involuntary leakage of stool and/or flatus, thus the results could be comparable to our definition of AI. However, the women were categorised as being incontinent if they had experienced symptoms within the past 4 weeks.…”

Section: Discussionmentioning

confidence: 63%

Prevalence of anal incontinence among Norwegian women: a cross-sectional study

et al. 2012

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ObjectiveAnal incontinence (AI) is a symptom associated with age, bowel symptoms and obstetric injuries. Primary aim of the study was to establish the prevalence of AI among women and secondarily to evaluate the impact on daily life and conditions associated with AI.DesignA cross-sectional study.SettingParticipants attended research stations located in different parts of Nord-Trøndelag county, Norway. Data were collected through interviews, questionnaires and clinical examinations.ParticipantsIn total, 40 955 community-dwelling women aged 30 years and older were invited. A total of 25 037 women participated, giving a participation rate of 61.1%.Primary and secondary outcome measuresFecal incontinence and flatal incontinence was defined as involuntary loss of feces and flatus weekly or more, respectively. AI was defined as the involuntary loss of feces and/or flatus weekly or more. Urgency was defined as the inability to defer defecation for 15 min. Statistical methods included prevalence estimates and logistic regression analysis.ResultsQuestions about AI were completed by 20 391 (82.4%) women. Among the 20 391 women, AI was reported by 19.1% (95% CI 18.6% to 19.7%) and fecal incontinence was reported by 3.0% (95% CI 2.8% to 3.2%). Urgency was experienced by 2586 women (12.7%, 95% CI 12.2 to 13.1). Impact on daily life was stated by 794 (26.0%, 95% CI 24.4 to 27.5) women with AI. In bivariate age-adjusted analysis of AI, OR and CI for urgency (OR 3.19, 95% CI 2.92 to 3.49) and diarrhoea (OR 3.81, 95% CI 3.32 to 4.38) revealed strongest associations with AI.ConclusionsAI affects one in five women older than 30 years. Strongest associated symptoms are urgency and diarrhoea.Trial registration numberThe study was approved by the Regional Committee for Medical and Health Research Ethics (No. 2009/1214) and followed the Declaration of Helsinki.

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Section: Discussionmentioning

confidence: 63%

Prevalence of anal incontinence among Norwegian women: a cross-sectional study

et al. 2012

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“…Obstetric factors are strongly associated with FI in women 54 and symptoms usually appear years later when aging and hormonal changes associated with menopause occur. 55 Large episiotomy, prolonged labor and use of forceps/spatula were factors much more prevalent in our patients compared with similar-aged HV. However, factors other than childbirth can be associated with FI.…”

Section: Discussionmentioning

confidence: 57%

“…had mild severity, scoring 0-5; 31.42%(55) reported moderate FI, scoring6-11; 47.42% (83) had severe FI, scoring 11-15 and finally, 14.28% (25) of the patients had very severe FI symptoms, scoring 16-20. According to FIQL score, incontinence reduced QoL especially in the coping and embarrassment subscales which decreased by nearly 50.00% Etiology of Fecal Incontinence: Obstetric and Coloproctological Risk Factors 2.29 ± 0.81 and 2.48 ± 0.83, respectively).…”

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confidence: 99%

Defective Conduction of Anorectal Afferents Is a Very Prevalent Pathophysiological Factor Associated to Fecal Incontinence in Women

Mundet

Cabib

Ortega

et al. 2019

J Neurogastroenterol Motil

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Background/AimsFecal incontinence (FI) is a prevalent condition among women. While biomechanical motor components have been thoroughly researched, anorectal sensory aspects are less known. We studied the pathophysiology of FI in community-dwelling women, specifically, the conduction through efferent/afferent neural pathways. MethodsA cross-sectional study was conducted on 175 women with FI and 19 healthy volunteers. The functional/structural study included anorectal manometry/endoanal ultrasound. Neurophysiological studies including pudendal nerve terminal motor latency (PNTML) and sensory-evoked-potentials to anal/rectal stimulation (ASEP/RSEP) were conducted on all healthy volunteers and on 2 subgroups of 42 and 38 patients, respectively. ResultsThe main conditions associated with FI were childbirth (79.00%) and coloproctological surgery (37.10%). Cleveland score was 11.39 ± 4.09. Anorectal manometry showed external anal sphincter and internal anal sphincter insufficiency in 82.85% and 44.00%, respectively. Sensitivity to rectal distension was impaired in 27.42%. Endoanal ultrasound showed tears in external anal sphincter (60.57%) and internal anal sphincter disruptions (34.80%). Abnormal anorectal sensory conduction was evidenced through ASEP and RSEP in 63.16% and 50.00% of patients, respectively, alongside reduced activation of brain cortex to anorectal stimulation. In contrast, PNTML was delayed in only 33.30%. Stools were loose/very loose in 56.70% of patients. ConclusionsPathophysiology of FI in women is mainly associated with mechanical sphincter dysfunctions related to either muscle damage or, to a lesser extent, impaired efferent conduction at pudendal nerves. Impaired conduction through afferent anorectal pathways is also very prevalent in women with FI and may play an important role as a pathophysiological factor and as a potential therapeutic target. (J Neurogastroenterol Motil 2019;25:423-435)

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“…our group did some previous studies focusing on hormonal changes and fi, mainly in menopause. 24,25 therefore we plan to investigate other stages of women's life that seem to be of paramount importance to the understanding of the development of functional bowel disorders. many factors have been described as contributors to pelvic floor disorders in pregnancy, including fi, such as increased abdominal pressure because of uterine volume and hormonal variations during pregnancy.…”

Section: Discussionmentioning

confidence: 98%