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Factors Associated with Symptom Severity in Women Presenting with Fecal Incontinence

Menees, S. B. M.D.1; Smith, T. M. M.D.2; Xu, X. Ph.D.2; Chey, W. D. M.D.1; Saad, R. J. M.D.1; Fenner, D. E. M.D.2

Diseases of the Colon & Rectum: January 2013 - Volume 56 - Issue 1 - p 97–102
doi: 10.1097/DCR.0b013e31826f8773
Original Contribution: Pelvic Floor

BACKGROUND: Fecal incontinence (FI) affects 2–12% of the US population. Identification of factors associated with worsening symptoms has important implications for prevention and treatment.

OBJECTIVE: The aim of our study is to assess factors associated with symptom severity in women presenting with FI.

DATA SOURCES: This was a prospective survey study.

STUDY SELECTION: Patients presenting to the Michigan Bowel Control Program Clinic for FI were prospectively enrolled between May 2005 and May 2009.

MAIN OUTCOME MEASURES: Factors associated with fecal incontinence severity.

RESULTS: Data on 231 women was analyzed with a mean age of 59.2 years (SD = 14.2) and mean BMI of 30.0 (SD = 8.6); 92% were white. Mean FISI score was 32.4 (SD = 15.3). Two-thirds of patients had a type 1–4 stool on the Bristol stool scale. Forty-one percent of subjects complained of urinary incontinence, 56.2% had an episiotomy, 29% had an operative delivery, and 15.1% reported a severe laceration with childbirth. The majority of patients (86.1%) reported FI for greater than 1 year, and 65.4% had previously sought care for FI. Bivariate analysis revealed that diabetes, IBS, urinary incontinence, history of operative delivery or severe laceration, fecal urgency, longer history of symptoms, previous health care for FI, and belief in treatment were positively associated with worse FISI score. In multiple linear regression analysis, increased FI symptom severity was shown to be associated with fecal urgency (0.0004), history of episiotomy (0.04), urinary incontinence (0.02), and diabetes mellitus (0.004).

limitations: This was a cross-sectional survey study performed at a Tertiary care center.

CONCLUSION: Patients with a history of episiotomy, diabetes, urinary incontinence, and fecal urgency have increased FI symptom severity. Proactive screening of patients with these medical histories is needed.

1 Internal Medicine, University of Michigan, Ann Arbor, Michigan

2 Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan

Financial Disclosures: None reported.

Poster presentation at the meeting of Digestive Disease Week, Chicago, IL, May 7 to 10, 2011.

Correspondence: Stacy B Menees, M.D., M.S., Department of Gastroenterology. University of Michigan, 3912 Taubman Center, SPC 5362, 1500 E. Medical Center Dr, SPC 5362, Ann Arbor, MI 48109. E-mail:

© The ASCRS 2013