Prevalence of anal incontinence in adults and impact on quality-of-life

Damon, Henri; Guye, Olivier; Seigneurin, Arnaud; Long, F. X.; Sonko, Abdoul; Faucheron, Jean‐Luc; Grandjean, Jean-Paul; Méllier, G; Valancogne, G.; Fayard, Marie-Odile; Henry, Luc; Guyot, Philippe; Barth, X.; Mion, François

doi:10.1016/s0399-8320(06)73076-7

Cited by 141 publications

(98 citation statements)

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“…It is known to be an under-reported problem, with many symptomatic patients suffering in silence. [5][6][7][8] FI has a significant impact on quality of life, causing social and psychological disability, 9,10 and often leads to people suffering from stigmatisation and social exclusion. 5,11,12 The attendant socioeconomic burden of FI is high not only because of the cost of health-care utilisation, but also because of job absenteeism.…”

Section: Introductionmentioning

confidence: 99%

Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial)

Horrocks

Bremner

Stevens

et al. 2015

Health Technol Assess

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BackgroundFaecal incontinence (FI) is a common condition which is often under-reported. It is distressing for those suffering from it, impacting heavily on their quality of life. When conservative strategies fail, treatment options are limited. Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive outpatient treatment, shown in preliminary case series to have significant effectiveness; however, no randomised controlled trial has been conducted.ObjectivesTo assess the effectiveness of PTNS compared with sham electrical stimulation in the treatment of patients with FI in whom initial conservative strategies have failed.DesignMulticentre, parallel-arm, double-blind randomised (1 : 1) controlled trial.SettingEighteen UK centres providing specialist nurse-led (or equivalent) treatment for pelvic floor disorders.ParticipantsParticipants aged > 18 years with FI who have failed conservative treatments and whose symptoms are sufficiently severe to merit further intervention.InterventionsPTNS was delivered via the Urgent®PC device (Uroplasty Limited, Manchester, UK), a hand-held pulse generator unit, with single-use leads and fine-needle electrodes. The needle was inserted near the tibial nerve on the right leg adhering to the manufacturer’s protocol (and specialist training). Treatment was for 30 minutes weekly for a duration of 12 treatments. Validated sham stimulation involved insertion of the Urgent PC needle subcutaneously at the same site with electrical stimulation delivered to the distal foot using transcutaneous electrical nerve stimulation.Main outcome measuresOutcome measures were assessed at baseline and 2 weeks following treatment. Clinical outcomes were derived from bowel diaries and validated, investigator-administered questionnaires. The primary outcome classified patients as responders or non-responders, with a responder defined as someone having achieved ≥ 50% reduction in weekly faecal incontinence episodes (FIEs).ResultsIn total, 227 patients were randomised from 373 screened: 115 received PTNS and 112 received sham stimulation. There were 12 trial withdrawals: seven from the PTNS arm and five from the sham arm. Missing data were multiply imputed. For the primary outcome, the proportion of patients achieving a ≥ 50% reduction in weekly FIEs was similar in both arms: 39 in the PTNS arm (38%) compared with 32 in the sham arm (31%) [odds ratio 1.28, 95% confidence interval (CI) 0.72 to 2.28;p = 0.396]. For the secondary outcomes, significantly greater decreases in weekly FIEs were observed in the PTNS arm than in the sham arm (beta –2.3, 95% CI –4.2 to –0.3;p = 0.02), comprising a reduction in urge FIEs (p = 0.02) rather than passive FIEs (p = 0.23). No significant differences were found in the St Mark’s Continence Score or any quality-of-life measures. No serious adverse events related to treatment were reported.ConclusionsPTNS did not show significant clinical benefit over sham electrical stimulation in the treatment of FI based on number of patients who received at least a 50% reduction in weekly FIE. It would be difficult to recommend this therapy for the patient population studied. Further research will concentrate on particular subgroups of patients, for example those with pure urge FI.Trial registrationCurrent Controlled Trials ISRCTN88559475.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 77. See the NIHR Journals Library website for further project information.

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Section: Introductionmentioning

confidence: 99%

Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial)

Horrocks

Bremner

Stevens

et al. 2015

Health Technol Assess

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“…The prevalence of fecal incontinence is estimated to be around 5% in the general population, being higher in women than in men and up to 40% in nursing homes [1,2] . The first step in treatment of all for ms of fecal incontinence is to regulate defecation with a fiber enriched diet, fiber supplementation and physiotherapy or biofeedback of the pelvic floor.…”

Section: Introductionmentioning

confidence: 99%

Anal plugs and retrograde colonic irrigation are helpful in fecal incontinence or constipation

Cazemier¹,

Felt‐Bersma²,

Mulder³

2007

WJG

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AIM:To evaluate the feasibility, clinical effect and predicting factors for favorable outcome of treatment with anal plugs in fecal incontinence and retrograde colonic irrigation (RCI) in patients with fecal incontinence or constipation. METHODS:Patients who received treatment with an anal plug or RCI between 1980 and 2005 were investigated with a questionnaire. RESULTS:Of the 201 patients (93 adults, 108 children), 101 (50%) responded. Adults: anal plugs (8), five stopped immediately, one stopped after 20 mo and two used it for 12-15 mo. RCI (40, 28 fecal incontinence, 12 constipation), 63% are still using it (mean 8.5 years), 88% was satisfied. Younger adults (< 40 years) were more satisfied with RCI (94 % vs 65%, P = 0.05).Children: anal plugs (7), 5 used it on demand for an average of 2.5 years with satisfactory results, one stopped immediately and one after 5 years. RCI (26 fecal incontinence, 22 constipation), 90% are still using it (mean time 6.8 years) and felt satisfied. Children tend to be more satisfied (P = 0.001). Besides age, no predictive factors for success were found. There was no difference in the outcome between patients with fecal incontinence or constipation. CONCLUSION:RCI is more often applied than anal plugs and is helpful in patients with fecal incontinence or constipation, especially for younger patients. Anal plugs can be used incidentally for fecal incontinence, especially in children.

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“…La prévalence était alors de 11 % pour l'incontinence globale et 5 % pour les pertes de selles. En 2006, une nouvelle étude a été réalisée auprès de personnes âgées de plus de 18 ans (âge moyen : 46,5 ans) issues de listes électorales de la région Rhône-Alpes [2]. L'incontinence anale était alors définie, selon les auteurs, par un score de Wexner supérieur ou égal à 5/20 (tableau I), ce qui correspond par exemple à au moins une perte de gaz quotidienne.…”

Section: éPidémiologie En Population Généraleunclassified

“…Une incontinence anale sévère (score de Wexner > 10, c'est-à-dire avec au moins des pertes régulières de selles) était retrouvée chez 0,8 % des sujets. Le descriptif des résultats des scores de Wexner est rapporté dans le tableau I. Ces auteurs montraient également que 87,9 % des patients incontinents se plaignaient d'une altération de leur qualité de vie, 36,2 % avaient un retentissement sur leur sexualité et 40,3 % portaient des protections à cause de ces fuites anales [2].…”

Section: éPidémiologie En Population Généraleunclassified

Épidémiologie et facteurs de risque de l’incontinence anale

Abramowitz

2013

Incontinence Anale De L’adulte

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DéfinitionsLe terme incontinence n'est pas spécifique, il peut exprimer l'incapacité à retenir les selles ou les urines. L'incontinence fécale est l'incapacité à retenir les matières (solides et/ou liquides) avec l'anus et l'incontinence anale (IA) est plus générale, y associant l'incapacité à retenir les gaz. On distingue également l'incontinence active et passive. La première implique que le patient a ressenti un besoin mais qu'il n'a pu se retenir, alors que l'incontinence passive est une perte sans besoin préalable. Le seuil de fréquence des pertes involontaires pour classer un patient dans la catégorie « incontinent » ne fait pas consensus : un patient est-il incontinent dès qu'il perd au moins un gaz par an, par mois, par semaine ou par jour ? La réponse n'est pas si évi-dente et est diversement tranchée selon les études, d'autant que le retentissement est très variable selon la vie et le travail des patients. Une perte de gaz occasionnelle sera vécue très difficilement par une personne ayant un métier de relation, alors qu'elle pourra être très bien tolérée chez quelqu'un travaillant chez soi ou en plein air. Enfin, en dehors de la perte de gaz ou de selles stricto sensu, la notion de suintements anaux est une réalité parfois aussi très invalidante pour les patients. Toutes ces définitions montrent la diversité des incontinences pouvant expliquer une partie des variations des données épidémiologiques. Depuis peu, certaines études essayent de s'approcher de la réalité du ressenti des patients en leur demandant par exemple (si possible par autoquestionnaire) s'ils se sentent incontinents, ou le nombre de jours sans fuite. L. Abramowitz ( ) -Unité de proctologie

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Prevalence of anal incontinence in adults and impact on quality-of-life

Cited by 141 publications

References 14 publications

Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial)

Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial)

Anal plugs and retrograde colonic irrigation are helpful in fecal incontinence or constipation

Épidémiologie et facteurs de risque de l’incontinence anale

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