Risk factors in acquired faecal incontinence

Abstract

SUMMARYAcquired faecal incontinence arising in the non-elderly population is a common and often devastating condition. We conducted a retrospective cohort analysis in 629 patients (475 female) referred to a tertiary centre, to determine the relative importance of individual risk factors in the development of faecal incontinence, as demonstrated by abnormal results on physiological testing.Potential risk factors were identified in all but 6% of patients (7 female, 32 male). In women, the principal risk factor was childbirth (91%), and in most cases at least one vaginal delivery had met with complications such as perineal injury or the need for forceps delivery. Of the males, half had undergone anal surgery and this was the only identified risk factor in 59%. In many instances, assignment of cause was hampered by a long interval between the supposed precipitating event and the development of symptoms. Abnormalities of anorectal physiology were identified in 76% of males and 96% of females (in whom they were more commonly multiple).These findings add to evidence that occult damage to the continence mechanism, especially through vaginal delivery and anal surgery, can result in subsequent faecal incontinence, sometimes after an interval of many years.

Outcome and cost analysis of sacral nerve stimulation for faecal incontinence

“…In the present series, the highest success rates were observed in patients with neurogenic aetiology (five of five) and small anal sphincter defects (14 of 16), mainly after a history of complicated vaginal delivery. These women frequently wait a long time before seeking advice, and childbirth may have taken place many years before the appearance of incontinence symptoms 16 . The incontinence is often of complex aetiology, caused by a combination of structural defect of the anal sphincter, rectal hypersensitivity and sphincter weakness by ageing and pudendal nerve dysfunction 16,17 .…”

“…These women frequently wait a long time before seeking advice, and childbirth may have taken place many years before the appearance of incontinence symptoms 16 . The incontinence is often of complex aetiology, caused by a combination of structural defect of the anal sphincter, rectal hypersensitivity and sphincter weakness by ageing and pudendal nerve dysfunction 16,17 . SNS can increase anal sphincter pressures, as shown by Rosen et al 18 , but it is most likely that an improvement in rectal sensibility in response to electrical stimulation increases continence and may explain the good results in this patient group.…”

Faecal incontinence and health related quality of life in inflammatory bowel disease patients: Findings from a tertiary care center in South Asia

“…FI is also known to be associated with vaginal delivery in women [13,14] . In addition, in both genders, FI can be associated with a range of pelvic floor disorders and perianal surgeries (e.g., haemorrhoidectomy and sphincterotomy) [15,16] . The only estimation of FI in IBD is from patients attending special clinics and the data from the Crohn's and Colitis Foundation of the United Kingdom, and the incidence ranged from 22%-33.5% [17][18][19] .…”

Underlying functional bowel disorder may explain patient dissatisfaction after haemorrhoidal surgery

“…Anal surgery appears to be the most common cause of faecal incontinence in men and in women with no history of difficult vaginal Correspondence to: Pr Laurent Siproudhis, Service des Maladies de l'Appareil Digestif, Centre Hospitalier Régional and Universitaire de Pontchaillou, 35033 Rennes-Cedex, France. E-mail: laurent.siproudhis@chu-rennes.fr delivery [6]. When one study focused on subjects suffering from faecal incontinence, causative anorectal surgery, mostly haemorrhoidectomy, was reported in 9% of participants in a large national survey [7].…”