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Fecal Incontinence Decreases Sexual Quality of Life, But Does Not Prevent Sexual Activity in Women

Imhoff, Laurel R. M.D., M.P.H.1; Brown, Jeanette S. M.D.2; Creasman, Jennifer M. M.S.P.H.2; Subak, Leslee L. M.D.2; Van Den Eeden, Stephen K. Ph.D.3; Thom, David H. M.D., Ph.D.4; Varma, Madhulika G. M.D.5; Huang, Alison J. M.D., M.A.S.6

doi: 10.1097/DCR.0b013e318265795d
Original Contributions: Pelvic Floor

BACKGROUND: The impact of anal incontinence on women’s sexual function is poorly understood.

OBJECTIVE: The aim of this study was to investigate the relationship between anal incontinence and sexual activity and functioning in women.

DESIGN: This is a cross-sectional study.

SETTINGS: This investigation was conducted in a community-based integrated health care delivery system.

PATIENTS: Included were 2269 ethnically diverse women aged 40 to 80 years.

MAIN OUTCOME MEASURES: Self-administered questionnaires assessed accidental leakage of gas (flatal incontinence) and fluid/mucus/stool (fecal incontinence) in the past 3 months. Additional questionnaires assessed sexual activity, desire and satisfaction, as well as specific sexual problems (difficulty with arousal, lubrication, orgasm, or pain). Multivariable logistic regression models compared sexual function in women with 1) isolated flatal incontinence, 2) fecal incontinence (with or without flatal incontinence), and 3) no fecal/flatal incontinence, controlling for potential confounders.

RESULTS: Twenty-four percent of women reported fecal incontinence and 43% reported isolated flatal incontinence in the previous 3 months. The majority were sexually active (62% of women without fecal/flatal incontinence, 66% with isolated flatal incontinence, and 60% with fecal incontinence; p = 0.06). In comparison with women without fecal/flatal incontinence, women with fecal incontinence were more likely to report low sexual desire (OR: 1.41 (CI: 1.10–1.82)), low sexual satisfaction (OR: 1.56 (CI: 1.14–2.12)), and limitation of sexual activity by physical health (OR: 1.65 (CI: 1.19–2.28)) after adjustment for confounders. Among sexually active women, women with fecal incontinence were more likely than women without fecal/flatal incontinence to report difficulties with lubrication (OR: 2.66 (CI: 1.76–4.00)), pain (OR: 2.44 (CI: 1.52–3.91)), and orgasm (OR: 1.68 (CI: 1.12–2.51)). Women with isolated flatal incontinence reported sexual functioning similar to women without fecal/flatal incontinence.

LIMITATIONS: The cross-sectional design prevented evaluation of causality.

CONCLUSIONS: Although most women with fecal incontinence are at high risk for several aspects of sexual dysfunction, the presence of fecal incontinence does not prevent women from engaging in sexual activity. This indicates that sexual function is important to women with anal incontinence and should be prioritized during therapeutic management.

1Department of Surgery, University of California, San Francisco–East Bay, Oakland, California

2Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California

3Division of Research, Kaiser Permanente Northern California, Oakland, California

4Departments of Family and Community Medicine, University of California San Francisco, San Francisco, California

5Department of Surgery, University of California San Francisco, San Francisco, California

6Department of Medicine, University of California San Francisco, San Francisco, California

Funding/Support: This research was funded by the National Institutes Diabetes, Digestive and Kidney Diseases (NIDDK) grant DK53335 and the NIDDK/Office of Research on Women’s Health Specialized Center of Research grant P50 DK064538. Dr Huang is additionally supported by a Paul B. Beeson Career Development Award in Aging Research from the National Institute on Aging (grant 1K23AG038335-01A1) and the American Federation for Aging Research.

Financial Disclosure: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: Laurel R. Imhoff, M.D., M.P.H., 1411 East 31st St, Oakland, CA, 94602. E-mail:

© The ASCRS 2012