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Fecal Incontinence

Community Prevalence and Associated Factors—A Systematic Review

Ng, Kheng-Seong M.B.B.S. (Hons.)1,2; Sivakumaran, Yogeesan M.B.B.S. (Hons.)1; Nassar, Natasha Ph.D.1,3; Gladman, Marc A. Ph.D., M.R.C.O.G, F.R.C.S. (Gen. Surg.), F.R.A.C.S.1,2

doi: 10.1097/DCR.0000000000000514
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BACKGROUND: Fecal incontinence is a chronic and debilitating condition with significant health burden. Despite its clinical relevance, the prevalence of fecal incontinence remains inconsistently described.

OBJECTIVE: This study aimed to systematically review the literature regarding the prevalence of and factors associated with fecal incontinence among community-dwelling adults.

DATA SOURCES: A search of the PubMed, Embase, and Cochrane databases was performed.

STUDY SELECTION: Studies that reported the prevalence of fecal incontinence and/or associated factors in a community-based (ie, unselected) adult population were included. Two independent assessors reviewed eligible articles.

MAIN OUTCOME MEASURES: Relevant data were extracted from each study and presented in descriptive form. The main outcome measures included the prevalence of fecal incontinence (adjusted and/or unadjusted), stratified for age and sex if reported; factors associated (and not associated) with fecal incontinence; and study quality, assessed using predefined criteria.

RESULTS: Of 3523 citations identified, 38 studies were included for review. The reported median prevalence of fecal incontinence was 7.7% (range, 2.0%–20.7%). Fecal incontinence equally affected both men (median, 8.1%; range, 2.3%–16.1%) and women (median, 8.9%; range, 2.0%–20.7%) and increased with age (15–34 years, 5.7%; >90 years, 15.9%). The study populations and diagnostic criteria used were heterogeneous, precluding any meaningful pooling of prevalence estimates. Study quality assessment revealed 6 high-quality studies, of which only 3 were performed in a representative sample. The median prevalence of fecal incontinence was higher in these studies at 11.2% (range, 8.3%–13.2%). The factors most commonly reported to be associated with fecal incontinence included increasing age, diarrhea, and urinary incontinence.

LIMITATIONS: Heterogeneity of studies precluded meaningful pooling or meta-analysis of data.

CONCLUSIONS: Fecal incontinence is a prevalent condition of equal sex distribution, affecting ≈1 in 8 community adults, and has identifiable associated factors. The paucity of high-quality prevalence studies emphasizes the need for future population-based studies that use standardized diagnostic criteria for fecal incontinence.

1 Academic Colorectal Unit, Sydney Medical School-Concord, University of Sydney, Sydney, New South Wales, Australia

2 Sydney Colorectal and Pelvic Floor Centre, Sydney, New South Wales, Australia

3 Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia

Funding/Support: Dr Ng is supported by National Health and Medical Research Council Postgraduate and Royal Australasian College of Surgeons' Foundation of Surgery research scholarships. Dr Nassar is supported by a National Health and Medical Research Council Career Development Fellowship (No. 632955).

Presented in part at the Tripartite Colorectal Meeting 2014, Birmingham, United Kingdom, June 30 to July 3, 2014. Published in abstract form in Colorectal Dis;2014;16(suppl 2):149.

Correspondence: Marc A. Gladman, Ph.D., M.R.C.O.G, F.R.C.S. (Gen. Surg.), F.R.A.C.S., Academic Colorectal Unit, Sydney Medical School-Concord, University of Sydney, Hospital Road, Concord NSW 2139, Australia. E-mail: m.a.gladman@sydney.edu.au

© 2015 The American Society of Colon and Rectal Surgeons