The differential impact of aging on fecal incontinence symptom severity and condition-specific quality of life remains unclear.
The purpose of this study was to characterize differences in symptom distress, quality of life, and anorectal physiology assessments in older versus younger women with fecal incontinence.
This was a cross-sectional study.
This study was conducted at a tertiary genitorectal disorder clinic.
Women presenting for fecal incontinence evaluation between 2003 and 2016 were classified as older or younger based on age ≥65 or <65 years.
The main outcomes were symptom-specific quality of life and distress measured by validated questionnaires (the Modified Manchester Health Questionnaire containing the Fecal Incontinence Severity Index); anorectal physiology and anatomy were assessed by manometry and endoanal ultrasound.
Of 879 subjects, 286 and 593 were classified as older and younger (mean ages, 71.4 ± 5.3 y and 51.3 ± 10.5 y). Solid stool leakage was more frequent in older women (83.2% vs 76.7%; p = 0.03), whereas liquid stool leakage (83.2% vs 82.8%; p = 0.88) and fecal urgency (76.9% vs 78.8%; p = 0.54) did not differ between groups. Mean symptom severity scores were similar between groups (28.0 ± 11.9 and 27.6 ± 13.5; p = 0.69); however, there was greater negative impact on quality of life among younger women (46.3 ± 22.0 vs 51.8 ± 21.8; p < 0.01). Multivariable linear regression controlling for pertinent covariates revealed younger age as an independent predictor for worse condition-specific quality-of-life scores (p < 0.01). Squeeze pressures were similar between groups, whereas younger women had greater resting pressures and higher rates of sphincter defects (external, 7.7% vs 20.2%; internal, 12.2% vs 26.8%; both p < 0.01).
This study was limited by its lack of patient obstetric history and the duration of their incontinence symptoms.
Characteristics differ between older and younger women seeking care for fecal incontinence. The differential impact and age-related phenotypes may provide useful information for patient counseling and developing management algorithms for women with fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A910.
1 Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2 Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
3 Birmingham/Atlanta Geriatrics, Research, Education, and Clinical Center at the Birmingham VA Medical Center, Departments of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
4 School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Funding/Support: This work was partially supported by the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development Women’s Reproductive Health Research Career Development Program (RFA HD-15-011).
Financial Disclosure: None reported.
Oral poster presentation at PFD Week 2017 of the American Urogynecologic Society, Providence, RI, October 3 to 7, 2017.
Correspondence: Isuzu Meyer, M.D., Division of Urogynecology and Reconstructive Surgery, University of Alabama at Birmingham, 1700 6th Ave South, Suite 10382, Birmingham, AL 35233. E-mail: firstname.lastname@example.org